Ophthamology

Question 1

What is the definition of hyperopia?

Answer 1

eye too short for refractive power of cornea and lens –> light focused behind retina

Question 2

What is the definition of myopia?

Answer 2

eye too long for refractive power of cornea and lens –> light focused in front of retina

Question 3

What is the definition of astigmatism?

Answer 3

abnormal curvature of cornea resulting in different refractive power at different axes

Question 4

What is the definition of presbyopia?

Answer 4

decrease in focusing ability during accommodation d/t sclerosis and decreased elasticity

Question 5

What is the definition of uveitis?

Answer 5

inflammation of anterior urea and iris, with hypopyon (sterile pus), accompanied by conjunctival redness

Question 6

What diseases are associated with uveitis?

Answer 6

sarcoid, RA, juvenile idiopathic arthritis, TB, HLA- B27 - assoc. conditions

Question 7

What is the definition of retinitis?

Answer 7

retinal edema and necrosis –> scarring

Question 8

What diseases are associated with retinitis?

Answer 8

immunosuppression

often VIRAL (CMV, HSV, HZV)

Question 9

What clinical findings are seen with central retinal artery occlusion?

Answer 9

acute, painless monocular vision loss

retina cloudy with attenuated vessels and “cherry-red” spot at the fovea

Question 10

What is the definition of retinal vein occlusion?

Answer 10

blockage of central or branch retinal vein d/t compression from nearby arterial atherosclerosis –> retinal hemorrhage and edema in affected area

Question 11

What are the 2 types of diabetic retinopathy?

Answer 11

Diabetic retinopathy = retinal damage d/t chronic hyperglycemia

Type 1: non-proliferative - damaged capillaries leak blood –> lipids and fluid seep into retina –> hemorrhages and macular edema. Tx: blood sugar control and macular laser

Type 2: proliferative - chronic hypoxia –> new blood vessel formation with resultant traction on retina Tx: peripheral retinal photocoagulation, anti-VEGF injections

Question 12

What structure of the eye collects aqueous humor that flows through the anterior chamber?

Answer 12

trabecular meshwork

Question 13

What structure in the eye collects aqueous humor from the trabecular meshwork?

Answer 13

Canal of Schlemm

Question 14

What are findings of glaucoma?

Answer 14

characteristic “cupping”

usually with increased intraocular pressure (IOP) and progressive peripheral visual field loss

Question 15

What risk factors are associated with open angle glaucoma?

Answer 15

Increased age
African Americans
family history

Question 16

What is the pathogenesis of primary closed/narrow angle glaucoma?

Answer 16

enlargement or forward movement of lens against central iris –> obstruction of normal aqueous flow through pupil –> fluid builds up behind iris –> peripheral iris pushed against cornea, impeding flow through trabecular meshwork

Question 17

What is the pathogenesis of secondary closed/narrow angle glaucoma?

Answer 17

hypoxia from retinal disease (e.g. diabetes, vein occlusion) –> vasoproliferation in iris that contracts angle

Question 18

Very painful, sudden vision loss, halos around lights, rock-hard eye, and frontal HA are associated with what emergent condition?

Answer 18

acute closed angle glaucoma

Question 19

What are risk factors for cataracts?

Answer 19

old age
smoking
alcohol
excessive sunlight
prolonged corticosteroid use
classic galactosemia 
galactokinase deficiency
diabetes (sorbitol)
trauma
infection

Question 20

What is papilledema?

Answer 20

optic disc swelling d/t increased intracranial pressure

Question 21

What physical exam findings will you see with papilledema?

Answer 21

enlarged blind spot

elevated optic disc with blurred margins seen on fundoscopic exam

Question 22

What can be observed with CN III damage?

Answer 22

eyes look DOWN and OUT
ptosis
pupillary dilation
loss of accommodation

Question 23

What can be observed with CN IV damage?

Answer 23

eyes move UPWARD

often have problems going down the stairs, may present with compensatory head tilt in the opposite direction

Question 24

What can be observed with CN VI damage?

Answer 24

medially directed eye that cannot abduct

Question 25

What is the nerve path for miosis?

Answer 25

1st neuron: Edinger-Westphal nucleus to ciliary ganglion via CN III 2nd neuron: short ciliary nerves to pupillary sphincter muscles

Question 26

What is the nerve path for mydriasis?

Answer 26

1st neuron: hypothalamus to ciliospinal center of Budge (C8-T2) 2nd neuron: exit at T1 to superior cervical ganglion (travels along cervical sympathetic chain near lung apex, subclavian vessels) 3rd neuron: plexus along internal carotid, through cavernous sinus; enters orbit as long ciliary nerve to pupillary dilator muscles

Question 27

How does illumination in 1 eye result in bilateral pupillary constriction?

Answer 27

light in either retina sends a signal via CN II to pretectal nuclei in midbrain --> activates bilateral Edinger-Westphal nuclei --> bilateral pupil constriction

Question 28

What is a Marcus Gunn pupil?

Answer 28

afferent pupillary defect where you see decreased bilateral pupillary constriction when light is shone in affected eye relative to unaffected eye. Caused by damage to OPTIC NERVE or SEVERE RETINAL INJURY

Question 29

With damage to CN III, what physical findings will you see?

Answer 29

a "down and out" gaze

Question 30

What is the pathogenesis of retinal detachment?

Answer 30

separation of neurosensory layer of retina from outermost pigmented epithelium --> degeneration of photoreceptors --> vision loss

Question 31

What is the treatment for retinal detachment?

Answer 31

surgical emergency!

Question 32

What is the pathogenesis of age-related macular degeneration?

Answer 32

degeneration of macula (central area of retina) --> distortion (metamorphosis) and eventual loss of central vision

Question 33

What are the two types of age-related macular degeneration?

Answer 33

1. Dry (nonexudative, >80%) | 2. Wet (exudative, 10-15%)

Question 34

Deposition of yellowish extracellular material in and beneath Bruch membrane and retinal pigment epithelium ("duress") and a gradual decrease in vision is characteristic of what eye disease?

Answer 34

DRY age-related macular degeneration

Question 35

Rapid loss of vision d/t bleeding secondary to choroidal neovascularization is characteristic of what eye disease?

Answer 35

WET age-related macular degeneration

Question 36

What is the treatment for wet age-related macular degeneration?

Answer 36

anti-vascular endothelial growth factor injections (anti-VEGF) or laser

Question 37

What nerve track loops around the inferior horn of the lateral ventricle?

Answer 37

Meyer loop

Question 38

What nerve track takes the shortest path via internal capsule?

Answer 38

Dorsal optic radiation

Question 39

What is the pathogenesis of internuclear ophthalmoplegia (INO)?

Answer 39

a lesion of the medial longitudinal fasciculus (MLF) results in lack of communication b/t the CN VI nucleus and CN III nucleus --> ultimately, nystagmus of one eye during abduction. NOTE: convergence of eyes is NORMAL

Question 40

If a person has right INO, this means which eye is paralyzed?

Answer 40

RIGHT eye