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Ophthalmology Flashcards

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1
Q

At what ages should infants be able to
1. Show visual fixation
2. Track across midline/to 180 deg
3. Conjugate gaze
4. Develop binocular vision
5. Accommodation

A
  1. 6-8 weeks
  2. 2 months - tracking 180 by 10 weeks
  3. 4 months
  4. between 3 and 7 months
  5. 2-3 months
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2
Q

Are infants nearsighted or farsighted at birth?

A

Farsighted
Due to the size and shape of the eye they are hyperoptic, but this decreases with growth
Premature or LBW infants are typically less hyperoptic or even myopic

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3
Q

When should you refer to Ophtho if an infant cannot fix?

A

3-4 months

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4
Q

When should I child first get visual acuity testing?

A

3-4 years

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5
Q

What can cause an abnormal red reflex? What is your first step?

A

Strabismus
Cataracts
Glaucoma
Retinoblastoma
High refractory error
Immediate referrral to ophtho

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6
Q

What is the most common cause for unilateral cataract?

A

Sporadic

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7
Q

Causes of bilateral cataracts

A

Autosomal dominant inheritance
Trisomies 13, 18, 21
Galactosemia and other metabolic abnormalities
TORCH infections

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8
Q

Risk factors for ROP

A

Prematurity
Low BW
Prolonged exposiure to high supplemental oxygen
Assisted ventilation for > 7 days
Surfactant therapy
Hyperglycemia
Insulin therapy
Cumulative illness severity

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9
Q

Dacryostenosis treatment and when to refer to ophtho

A

Treatment is lacrimal sac massage
Refer for possible probing if it persists after 6-7 months

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10
Q

Treatment for stye (hordeolum)

A

Usually self limiting and resolves in 5-7 days
Warm compresses to help with secretions and blood flow to gland
Topical antibiotic can be used if there is blepharitis (eyelid inflammation)
Systemic antibiotics only if associated cellulitis

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11
Q

Difference between stye (hordeolum) and chalazion

A

Stye is infectious - lesion of the eyelid from follicle gland or meibomian gland
Chalazion is non-infectious - lesion of the eyelid from obstruction of meibomian gland with granulomatous inflammation

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12
Q

Treatment for chalazion

A

Typically resolves on own in few months
NO ANTIBIOTICS
Protracted cases, increasing pain, or obstructing vision = refer to ophtho

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13
Q

2 physical exam maneuvers to detect strabismus

A

Corneal light reflex test
Cover/uncover test

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14
Q

Meaning of
1. Protanopia
2. Deuteranopia

A
  1. Loss of L cones (red), results in blue-green vision
  2. Loss of M cones (green), results in red-blue vision
    Both more common in boys
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15
Q

Where in the nervous system does
1. Upbeating jerk nystagmus
2. Downbeating jerk nystagmus
suggest an injury?

A
  1. Pons, can be medulla or cerebellum
  2. Cervicomedullar junction
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16
Q

Most common causes of optic atrophy in children

A

Intracranial tumors
Hydrocephalus

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17
Q

Examples of midline facial defects

A

Optic nerve hypoplasia
Neural tube defects
Single central incision
Cleft lip/palate
TEF
Conotruncal heart defects
Diaphragmatic hernia
Omphalocele
Imperforate anus
Microphallus or undescended teste

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18
Q

Causes of secondary glaucoma in children

A

Trauma
Intraocular hemorrhage
Surgical complications (after cataract removal)
Chronic steroid use
Sturge-Weber syndrome

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19
Q

Red flags in a painful red eye which should prompt referral to ophtho

A

Vision abnormalities
Distorted pupil
Corneal involvement

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20
Q

Red, watery eye with gritty sensation

A

Adenovirus most common
No treatment, may get relief from lubricating drops

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21
Q

Common causes of bacterial conjunctivitis

A

Strep pneumo
H flu
Moraxella catarrhalis

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22
Q

Treatment for bacterial conjunctivitis

A

Erythromycin ointment or Septra drops for 5-7 days
Use fluoroquinolone drops for contact wearers due to risk of Pseudomonas
24 hours of therapy before going to school

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23
Q

Should corneal abrasions be reassessed?

A

Yes
Recheck in 24-48 hours for resolution

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24
Q

How to distinguish between preseptal and orbital cellulitis

A

Both have eye pain and red, swollen eyelid
Orbital –> pain with eye movements, ophthalmoplegia, chemosis, and/or proptosis

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25
Treatment of orbital cellulitis
IV antibiotics (vanco, ceftriaxone, +/- metronidazole) for 3-5 days Then oral therapy for total 2-3 weeks Surgery may be required if not responding as expected
26
Complications of orbital cellulitis
Orbital abscess Subperiosteal abscess Intracranial extension
27
Causes of papilledema
Mass Brain abscess Cerebral edema Noncommunicating hydrocephalus Idiopathic intracranial hypertension
28
Treatment for hyphema
Refer to ophtho Protect eye with a rigid shield Steroids and cytoplegic drops Alleviate vomiting and pain as they can increase intraocular pressure Prevent secondary bleeding with antifibrinolytic therapy
29
When is the highest rebleeding risk with hyphema
In the first week after injury Increases risk for long term complications like glaucoma
30
Symptoms of orbital floor fracture
Vertical diplopia Limited vertical gaze (entrapment of inferior rectus muscle) Circumferential ecchymosis Subconjunctival hemorrhage Hypema Enophthalmos
31
Retinal findings in Tay Sach's disease
Pale optic disc Cherry red spot in the macula
32
When to screen for ROP
31 weeks corrected OR 4 weeks of life Whichever is LATER
33
What genetic syndromes are associated with a coloboma
CHARGE syndrome Cat-eye syndrome Trisomy 13 and 18 Kabuki syndrome Walker-Warburg syndrome MIDAS syndrome DiGeorge syndrome +++ others
34
Unique ocular finding of Williams syndrome
Stellate iris
35
Most common cause of unilateral cataracts
Idiopathic Bilateral more concerning for underlying pathology
36
Concerning complication post cataract removal surgery
Secondary glaucoma
37
How to tell between 1. Bacterial 2. Viral 3. Allergic conjunctivitis
1. Purulent, usually one eye but can be both 2. Watery discharge, often starts in one eye then spreads to other in 24-48 hours 3. Watery, stringy discharge, ITCHY
38
Causes of acquired 6th nerve palsy
Increased ICP Meningitis Mass Vascular anomalies Trauma Idiopathic Post viral
39
1. When to screen for ROP 2. Who to screen
1. 31 weeks or 4 weeks of life, whichever is later 2. < 31 weeks, < 1250g
40
Symptoms of optic neuritis
Reduced visual acuity RAPD Periocular pain May have changes to colour vision Visual field defects Hyperemic/swollen disc on fundoscopy
41
Anterior uveitis
Inflammation of the iris and ciliary body
42
Complications of uveitis
Band keratopathy Posterior synechiae Cataracts Intraocular hypertension
43
Treatment for anterior and posterior uveitis
Anterior = topical steroids Posterior = systemic steroids Patients will often need systemic immunosuppresion for long term therapy (MTX, cyclosporine, TNF a inhibitors)
44
Role of cycloplegic agents (atropine) in uveitis
Prevent adhesion of the iris to lens
45
Indications to refer bacterial conjunctivitis to ophtho
Vision loss Severe purulent discharge Corneal involvement Conjunctival scarring Recurring symptoms Severe pain HSV infection Severe photophobia Involvement with contact lens
46
Chorioretinitis causes and findings
Scars on retina Ex: toxo, CMV, syphilis, sarcoidosis
47
Intracranial complications from mastoiditis
Meningitis Temporal lobe or cerebellar abscess Epidural or subdural abscess Venous sinus thrombosis
48
Extracranial complications of mastoiditis
Subperiosteal abscess Facial nerve palsy Hearing loss Labrynthitis Osteomyelitis Benzold abscess (in SCM)
49
Classic triad of glaucoma
Tearing Photophobia Blepharospasm
50
Ocular findings of vitamin A deficiency
Night or complete blindness Dry eyes (xerophthalmia) Corneal scarring
51
Symptoms of retinal detachment
Acute vision loss (peripheral and/or central) Flashing lights and floaters Shade over one eye May see an RAPD
52
Symptoms of vitreous hemorrhage
Decreased or hazy vision, black spots, cob webs May have absent red reflex with large hemorrhage CT for trauma
53
Treatment of corneal abrasions
Topical antibiotic ointment Oral analgesia Do NOT prescribe topical anesthetics
54
What nerves innervate the muscles of the eye?
LR6 = CN 6 for lateral rectus SO4 = CN 4 for superior oblique CN 3 for rest = superior, medial and inferior rectus, inferior oblique CN 3 also controls levator palpebrae that raises eyelid, as well as pupil constriction
55
Movements of the eye muscles
Rectus muscles = in the name (medial, lateral, superior, inferior) Superior oblique = internal rotation, depression Inferior oblique = external rotation, elevation, abduction
56
Decreased visual acuity, eye pain worse with movements, headache, decreased colour vision, visual field defects If unilateral, RAPD
Optic neuritis
57
Who to screen for ROP
Infants < 31 weeks Infants < 1250 g
58
When to screen for ROP
31 weeks corrected OR 4 weeks of life, whichever is LATER
59
Treatment for ROP
Laser ablation of the avascular portion of the retina
60
Nyctalopia
Night blindness Often from Vit A deficiency
61
Dacryoadenitis 1. symptoms 2. Causes
Inflammation of the lacrimal gland 1. pain, redness, swelling over lacrimal gland, increased tearing or drainage, periauricular lymphadenopathy 2. Mumps, flu, EBV, herpes, sarcoid, TB, syphilis
62
Gene involved in retinoblastoma
RB1 on long arm of chromosome 13 Need mutation in both members of a gene pair
63
Retinoblastoma clinical findings
Leukocoria Strabismus Periorbital erythema Ocular proptosis Vision loss
64
What is the prognosis for retinoblastoma
Good, but high risk of other cancers later on in life Osteosarcoma, pineal tumor, soft tissue sarcomas, melanomas
65
Anisometropia
Vision in one eye is worse than the other due to high refractive error
66
Horner syndrome triad
Damage to sympathetic supply Partial ptosis Facial anhidriosis Miosis

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