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Flashcards in ophthalmology Deck (30):
1

myopia

light focuses in front of the retina

2

hyperopia

light focused behind the retina

3

astigmatism

asymmetry of the corneal surface, blurred vision

4

strabismus

deviation of one eye; double vision, progressive blindness in one eye as the brain ignores one eye (ambylopia)

5

Ambylopia

brain stops processing visual information from one eye

developmental defect

most common cause if strabismus

Treat with vision training- patch the good yee

6

MCC blindness >55yo

macular degeneration

7

MCC blindness

DM

8

MCC blindness in anyone black

glaucoma

9

Conjunctiitis most common viral cause

MCC viral- adenovirus

10

bacterial conjunctivitis

s. aureus, s. pneumonia, n. gonorrheae, chlamydia trachomitis

11

Most likely cause of conjunctivitis appearing in the first 24 hours of life?

chemical conjunctivitis resulting from antibiotic eye drops newborns receive

12

uveitis

inflammation of iris, ciliary bodies, and/or choroid

may be anterior or posterior
Anterior: pain and redness of iris, photophobia
Posterior: mild vision abnormalities. CMV, toxoplasma, cat scratch disease

may be 2/2 infection, or autoimmune, or rheumatic disease
PAIR
psoriatic arthritis
ankylosing spondylitis
IBD-related arthritis
Reactive arthritis

kawasaki disease

13

red eye and corneal ulceration

herpes simplex keratitis

14

red eyes and collagen- vascular disorder

uveitis or scleritis

15

red eyes and colored halos

acute angle- closure glaucoma

16

red eyes and itchiness

allergic conjunctivitis

17

red eyes and preauricular lymph node enlargement

viral conjunctivitis

18

red eyes that are dry

keratoconjunctivitis sicca (complication of SJS)

19

red eyes and shallow anterior chamber

acute angle- closure glaucoma

20

orbital versus periorbial cellulitis

orbital cellulitis is more severe than periorbital cellulitis, involving more than just the skin. Neither involves the eyeball

orbital cellulitis:
proptosis
contents of orbit involved
pain with eye movement
weakness or paralysis of EOMs (ophthalmoplegia)
impaired vision

can be deadly

21

Inflammatory conditions of the eyelids:
chalazion

inflammation of internal Meibomian sebacious glands (eyelid swelling), deep in the eyelid

treat- usually self- limiting, but can be surgically excised, or intralesional steroid injection

22

Inflammatory conditions of the eyelids:
hordeolum

infection of external sebaceous glands of Zeiss or Mol (tender, red swelling at lid MARGIN)

Treat with hot compress 3-4 times per day for 10-15 minutes, if unresolved in 48 hours, then I&D, +/- antibiotic ointment q3 hours

23

Inflammatory conditions of the eyelids:
anterior blepharitis

infection of eyelids and lashes secondary to seborrhea (red, swollen, lid margins + dandruff on lashes)

Wash lid margins daily with shampoo, remove scales daily with cotton ball, antibiotic ointment daily to lid margins

24

how do you treat acute angle- closure glaucoma?

the angle closes between the iris and sclera, closing off canal of schlemm to anterior fluid, fixed mid- dilated pupil, rock hard eyeball

pressure- lowering eye drop regimen: 1 drop each eye, one minute apart of 0.5% timolol, 1% apraclonidine, 2% pilocarpine

acetazolamide 250mcg 2 tabs once

IV mannitol in refractory cases confirmed by an opthalmologist

you want to get the patient to an ophthalmologist within an hour for laser iridotomy

25

open angle glaucoma treatment

trabecular meshwork is clogged up for reasons not having to do with angle

more gradual and common than acute. often bilateral unlike acute. increased cup to disk ratio to >50%, or tonometry

Treat with latanaprost (prostaglandins increase outflow of aqueous humor)

topical beta blockers (inhibits production of aqueous humor)

alpha2 adrenergic agonists decrease beta- adrenergic stimulation, decrease production of aqueous humor, increase outflow of aqueous humor

cholinergic agonists (pilocarpine), constricts the pupil, thereby opening up the trabecular meshwork

carbonic anhydrase inhibitors (Acetazolamide), which prevents production of humor.

lasers can be used to drill holes in the meshwork

26

macular degeneration

the macula is a spot on the retina that is packed with cone cells that provide fine central vision

without the macula, peripheral vision is intact

dry (Atrophic, drusen accumulates on retina, gradual loss of vision) and wet (sudden onset with rapid progression and neovascularization)

slit lamp exam for dry
fluorescein angiogram for wet

treatment:
stop smoking
anti-vegf into vitreous humor
antioxidants (zinc, vit C, vit E)
+/- intravitreal ranizumab injection

27

retinal detachment

painless sudden loss of vision
sudden onset of flashing lights and floaters
reduction in vision

treatment:
laser photocoagulation
cryotherapy
surgical reattachment of the retina

28

central retinal artery occlusion

sudden painless vision loss, vision suddenly gone, dramatic

pale retina with a cherry red spot on the macula (blood vessels behind this spot are visible)

treat: throbolytics, acetazolamide, mannitol, stick a needle in the eye to reduce intraocular pressure to improve perfusion, give oxygen

29

retinal hemorrhage

dilated veins, cotton wool spots
Tx: VEGF inhibitors

30

Corneal abrasion treatment

thorough eye exam with removal of foreign body by irrigation

topical antibiotics QID continued 3-5 days or until the eye is symptom- free for 24 hours (ointment>drops)- erythromycin, sulfacetamide, ciprofloxacin, ofloxacin

OTC lubricant (refresh PM, lacri-lube) as needed up to hourly

pressure patching is optional for the first 24 hours, and is contraindicated if a foreign body is present. no role for pirate patch

pain control with systemic opioids, or ophthalmic NSAIDs (diclofenac, ketorolac)

do not prescribe topical anesthetic or topical steroids