ophthalmology

Question 1

myopia

Answer 1

light focuses in front of the retina

Question 2

hyperopia

Answer 2

light focused behind the retina

Question 3

astigmatism

Answer 3

asymmetry of the corneal surface, blurred vision

Question 4

strabismus

Answer 4

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

Question 5

Ambylopia

Answer 5

brain stops processing visual information from one eye

developmental defect

most common cause if strabismus

Treat with vision training- patch the good yee

Question 6

MCC blindness >55yo

Answer 6

macular degeneration

Question 7

MCC blindness

Answer 7

DM

Question 8

MCC blindness in anyone black

Answer 8

glaucoma

Question 9

Conjunctiitis most common viral cause

Answer 9

MCC viral- adenovirus

Question 10

bacterial conjunctivitis

Answer 10

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

Question 11

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

Answer 11

chemical conjunctivitis resulting from antibiotic eye drops newborns receive

Question 12

uveitis

Answer 12

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

Question 13

red eye and corneal ulceration

Answer 13

herpes simplex keratitis

Question 14

red eyes and collagen- vascular disorder

Answer 14

uveitis or scleritis

Question 15

red eyes and colored halos

Answer 15

acute angle- closure glaucoma

Question 16

red eyes and itchiness

Answer 16

allergic conjunctivitis

Question 17

red eyes and preauricular lymph node enlargement

Answer 17

viral conjunctivitis

Question 18

red eyes that are dry

Answer 18

keratoconjunctivitis sicca (complication of SJS)

Question 19

red eyes and shallow anterior chamber

Answer 19

acute angle- closure glaucoma

Question 20

orbital versus periorbial cellulitis

Answer 20

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

Question 21

Inflammatory conditions of the eyelids:

chalazion

Answer 21

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

Question 22

Inflammatory conditions of the eyelids:

hordeolum

Answer 22

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

Question 23

Inflammatory conditions of the eyelids:

anterior blepharitis

Answer 23

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

Question 24

how do you treat acute angle- closure glaucoma?

Answer 24

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

Question 25

open angle glaucoma treatment

Answer 25

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

Question 26

macular degeneration

Answer 26

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 ```

Question 27

retinal detachment

Answer 27

painless sudden loss of vision sudden onset of flashing lights and floaters reduction in vision treatment: laser photocoagulation cryotherapy surgical reattachment of the retina

Question 28

central retinal artery occlusion

Answer 28

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

Question 29

retinal hemorrhage

Answer 29

dilated veins, cotton wool spots | Tx: VEGF inhibitors

Question 30

Corneal abrasion treatment

Answer 30

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