Ophthalmology High Yield Questions Flashcards
(31 cards)
Presbyopia (also known as age-related nearsightedness
) is 2/2 what?
- 2/2 loss of elasticity of the crystalline lens
- results in decreased accommodating power when seeing objects at arm’s length or closer
- image focuses behind the retina
Amblyopia (strabismus: MC; Refractive error 2nd MC)
Tx question?
- Patching or optic penalization
- patching: occluding the “better” eye to encourage use of the amblyopic eye
- optic penalization: atropine, a cycloplegic (i.e. anticholinergic therefore dilator), is added to the “better” eye
- both are equally effective
Lens dislocation direction is a/w what etiology?
Superior?
Inferior?
Variable?
superior dislocation: Marfan syndrome
inferior dislocation: homocystinuria
variable dislocation: Alport’s Syndome
Pterygium (Fleshy benign growth from conjunctiva onto the nasal side of the cornea a/w wind, sand, sun, dust)
Higher incidence in what countries?
countries closer to equator
Subconjunctival Hemorrhage
Tx?
Observation b/c typically resolves in 24-48 hours
Viral Conjunctivitis
Tx?
Treatment: self limited; warm compresses for symptomatic relief; no medical treatment
Allergic conjunctivitis
Presentation/hallmark symptoms
painless
marked puritis (ITCHY=Hallmark)
bilateral watery eyes
Herpes Simplex Keratoconjunctivitis (Corneal involvement is often precipitated by topical or systemic corticosteroid treatment)
Evaluation?
Tx?
- Fluoroscein stain examination
- exam exhibits a shallow ulcer with a dendritic appearance and irregular borders
Tx: Topical antivirals: idoxuridine, vidarabine, trifluridine
Trachoma: Caused by Chlamydia trachomatis serotype A-C and PE demonsrates a pannus formation on cornea
Constant corneal irritation results in …?
Treatment?
- Constant corneal irritation results in conjunctivitis and **neovascularization
Tx:
- *1. topical tetracycline
2. oral azithromycin
Uveitis
Caused by…
Tx?
- Autoimmune Disorders
1. alkylosing spondylitis
2. juvenile rheumatoid arthritis
3. inflammatory bowel disease
4. sarcoidosis - *5. trauma or ophthalmic surgery can cause a similar condition sympathetic ophthalmia
- Infection
1. cytomegalovirus
2. syphillis
3. tuberculosis
Tx: roids
Endophthalmitis
What is it?
Tx?
- infection on the vitreous fluid that classically follows an eye operation
Tx: intravitreal antibiotics
Cataracts
Symptoms?
Physical exam?
Symptoms**
- painless, progressive, and slow vision loss
- Physical exam
absent red reflex
Diabetic Retinopathy
Proliferative? TX?
- result of vessel growth in the retina (neovascularization)**
TX:
- medical: VEGF inhibitors (bevacizumab)
- surgical: pan retina laser treatment
- tight glucose control
Diabetic Retinopathy
Non-Proliferative? TX?
- result of ischemic and edema damage to the retina
TX:
- surgical: focal retina laser treatment
- tight glucose control
Dry Age-Related Macular Degeneration (ARMD)
Treatment ?
zinc and antioxidant vitamins
Wet Age-Related Macular Degeneration
Treatment?
wet-ARMD
VEGF inhibitors (e.g., bevacizuzmab)
photodynamic therapy
zinc and antioxidant vitamins
Retinal Detachment
- ***painless sudden vision loss
- photopsia (sudden flashes or light)
- “floaters” in the visual field
(the extent of retinal detachment can be assessed by the number of floaters present)
Physical exam
- gray, elevated retina
Retinal Artery Occlusion
when is it termed Amaurosis Fugax?
If the plaque is small and vision spontaneously returns with passage of the clot, it is termed amaurosis fugax
Retinal Artery Occlusion/ Amaurosis Fugax
Symptoms and Diagnostic test
- sudden, painless, and complete loss of vision in one eye
- must evaluate the carotid artery: options are Doppler or CTA/MRA
Retinal Artery Occlusion/Amaurosis Fugax
Non-surgical tx option if surgical intervention is not readily available?
- digital massage of globe
- CO2 rebreathing & ocular massage
- both function to dilate retinal vessels in an attempt to pass the clot into a distal segment of the occluded vessel
CMV Retinitis: Painless vision loss
- Seen most commonly in HIV positive patients with CD4+ counts < 50; these patients are also at risk for HSV retinitis which presents similarly but is associated with eye pain
Fundoscopy exam show?
Tx?
- yellowish-white patches of retinal opacification
note that in HSV retinitis the findings include peripheral lesion and central necrosis of the retina
Tx: valgancyclovir
Open Angle Glaucoma Sx
- usually asymptomatic
- insidious onset of peripheral vision loss
Close (angle-closure) Glaucoma
Sx?
Evaluation?
- acute onset of blurry vision
- painful
- halos around lights
- ↓ vision (photophobia/blurry vision)
- perform a Gonioscopy: gold standard for angle-closure glaucoma
Close (angle-closure) Glaucoma
Tx?
- iridotomy
- topical β-blockers and α2-agonists
- oral carboanhydrase inhibitors (acetazolamide)
** Contradicted: epinephrine b/c alpha 1 α1-agonism causes mydriasis
