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Flashcards in Ophtho Deck (98):
1

Dacryocystitis

Infection of lacrimal sac

Usually in infants and adults > 40 yo

Sudden onset pain and redness in medial canthal region.

Sometimes have purulent d/c from punctum

Staph aureus and b-hemolytic Strep usual organisms

2

Episcleritis

infection of episcleral tissue b/n conj and sclera

Mild-moderate discomfort, photophobia, watery discharge

3

Hordeolum

abscess over upper or lower eyelid
- of ciliary follicle and glands along lid margin

usually due to staph aureus

red, tender swelling

Tx:
- warm compress
- topical abx

4

Chalazion

Lid discomfort

chronic granulomatous inflmmation of meibomian gland

Hard, painless lid nodule

Tx:
- usually regress spontaneously
- may require excision

5

Orbital cellulitus

Infection posterior to orbital septum

Unilateral

Kids more

Fever, proptosis, restriction of EOM, swollen and red eyelids

6

Allergic conjunctivitis

Acute hypersensitivity caused by environmental allergens

PMH of atopic dermatitis, asthma, eta, usually

Sx: intense itching, hyperemia, tearing, conj edema, eyelid edema

Tx: topical antihistamines, artificial tears, cool compresses

7

Atopic keratoconjunctivitis

Severe form of ocular allergy

Itching, tearing, thick mucous discharge, photophobia, blurred vision

8

Painful retinitis / retinal necrosis + keratitis + conjunctivitis + rapid visual loss

HSV retinitis

Fundoscopy - widespread, pale, peripheral lesions and central necrosis of the retina

9

Painless retinitis

CMV retinitis

Fundoscopy - fluffy/granular retinal lesions near retinal vessels + associated hemorrhages

10

Endophthalmitis

#1 form is postoperative - usually within 6 weeks of surgery

Change in vision is common

Candida can also cause

11

Amaurosis fugax

Warning that there is a stroke coming!

Can be other etiologies like retinal detachment, optic neuritis

Usually caused by retinal emboli from ipsilateral carotid artery

Transient monocular blindness lasting only a few minutes - "curtain falling down"

Whitened, edematous retina following distribution of retinal arterioles

Vascular in origin usually

Usually in people w/ atherosclerosis, CAD or HTN

Do a duplex US of neck

12

Central retinal artery occlusions
- sx
- cause
- what it looks like

Sx: Sudden painless loss of vision in 1 eye

Cause:
atheromatous particles
emboli
local retinal A compression

Result:
Usually irreversible vision loss

Pallor of optic disc (ischemic retinal whitening)

cherry red fovea

boxcar segmentation of blood in retinal arteries and veins

13

Central retinal vein occlusion
- sx
- causes

Sx: Sudden painless unilateral loss of vision

Cause: Usually in HTN pts

Result:
Visual loss variable (vs irreversible in CRAO)

Disk swelling

venous dilation + tortuosity

streaky linear retinal hemorrhages

cotton wool spots

15

Best diagnostic for acute glaucoma

Tonometry

16

Tx central retinal artery occlusions

Ophthalmologic emergency

Ocular massage --> dislodges embolus to help perfuse

Can use anterior chamber paracentesis to lower IOP

Carbogen therapy (5% CO2, 95% O2)

17

Dx corneal abrasions or herpes keratitis

Fluorescein stain of eye

18

Macular degeneration

Early findings - distortion of straight lines such as they appear wavy

Driving and reading one of first activities affected

19

Episcleritis

Inflammation of tissue b/n conj and sclera

Strongly assoc w/ rheumatoid arthritis and IBD

20

Cause of blindness via Giant Cell Arteritis

Ischemic optic neuropathy because involve ophthalmic artery

Will cause permanent blindness

21

Anterior uveitis

Red eye w/ leukocytes in anterior chamber

Inflammation of ciliary body and iris

22

Uveitis associations

Sarcoidosis

Ankylosing spondylitis

23

External hordeolum

THis is a stye!

Common staph abscess of eyelid

Tx w/ warm compresses

24

Sympathetic ophthalmia

Spared eye injury

Immune-mediated inflammation of 1 eye after penetrating injury to the other eye
- due to uncovering of hidden antigens
- break open eye, expose immune sys to these antigens in immune-privileged cite

Usually p/w anterior uveitis

25

Acute angle closure glaucoma - characteristics- consequences

Severe painvision losshalos around lightspupils dilatedInjected appearing scleraTearing, N/VPermanent vision loss 2-5 hrs after onset

26

Optic neuritis

Painful loss of vision

Central visual field defect

Fundoscopy normal

27

Tx diabetic retinopathy

Laser photocoagulation

28

Tonometry

Measures IOP

29

Tx OA glaucoma

Beta blocker

Alpha agonist

Carbonic anhydrase inhibitor

Prostaglandin analog

30

Tx AAC glaucoma

Pilocarpine drops

IV acetazolamide

Oral glycerin

31

Tx AAC glaucoma

Pilocarpine drops

IV acetazolamide

Oral glycerin

32

Pale optic nerve a sign of

Prior infarction (ischemic optic neuropathy)

Prior inflammation (MS, optic neuritis)

33

Ddx retinitis pigmentosa

Abetalipoproteinemia
Mt disease
Bardet-Biedl syndrome
Laurence Moon syndrome
Freidreich ataxia
Refsum disease

34

Retinitis pigmentosa
- mutation
- what happens

Chr 3 mutation

Degeneration of retinal receptors + adjacent pigment cells

Degeneration progresses: small accumulations of pigment appear around periphery of retina
Optic disc palor later evident in disease

35

Retinal phakomas

Gliomatous tumors

No tx needed

Principal components need for makign diagnosis of tuberous sclerosis

36

Red glass test

Get 2 images if eyes not moving together

Red image appears to L indicating eye covered by red glass not moving to left as much as other eye

REMEMBER:
- assume that eye is not moving where red image appears to be

37

Congenital cataracts infections

Rubella
CMV

38

Ddx leukocoria in infant

Can be opacification of lens (cataract) or retina is white

Cataract:
- rubella
- CMV

Retina:
- scar from retinopathy of prematurity
- retinoblastoma

39

Glaucoma can develop in 1/3 of children with what disease?

Sturge weber

40

B12 deficiency scotoma

Blind spot enlarges and extends temporally to involve macula

Similar to blind spot w/EtOH and tobacco excess = tobacco-alcohol amblyopia (B1 deficiency)

41

Acute large central scotoma
- ddx?

Methyl alcohol intoxication

42

Papillitis vs/ papilledema

Papillitis (inflamm optic N head)
- visual loss
- pain w/ eye mvmts
- sensitivity to light
- pressure on globe
- early sign of MS usually

Papilledema:
- no visual loss

43

Tunnel vision vs. Concentric constriction

Concentric constriction
- area perceived enlarges as test screen moved farther away from patient
- overall visual field always smaller than normal vis field
- if assoc w/ optic atrophy, can happen from neurosyphilis

Tunnel vision
- same size field even if test screen moved farther away
- not physiologic pattern of visual loss
- should suggest conversion d/o or malingering

44

Marcus Gunn (afferent pupillary) defect

Dx w/ swinging flashlight test

Often in ppl w/ MS as sequela of optic neuritis

Damage to optic N --> reduce light perception in affected eye

Pupil constrict bilaterally if shine in unaffected eye
Pupil dilate if shone in affected eye

45

Nyctalopia

Night blindness

Happens w/
retinitis pigmentosa
vit A deficiency
color blindness

46

Scintillating scotomas

classic for migraine aura

47

Long standing HTN --> retina changes?

Segmental narrowing of arterioles
- can get nicking as arterioles cross over veins

48

Most common eye muscle nerve palsy

6th nerve (abducens) > 3rd N > 4th N

49

Causes of abducens dysfunction w/ LR palsy in:
- kid
- adult

Kid
- increased ICP
- direct damage to brainstem (brainstem glioma)

Adults:
- nasopharynx mets to N
- vascular disease

50

Gradenigo syndrome

Facial sensation + LR palsy

Happens w/ osteomyelitis of petrous pyramid

Abducens and trigeminal N affected as pass close to tip of petrous bone

Chronic ear infections can extend to petrous and produce syndrome

51

#1 eye muscle N damaged w/ trauma to face

4th cranial nerve = trochlear

SO muscle extends far anterior into orbit --> high risk of injury w/ trauma to orbit or full face

Get head tilt w/ injured muscle

52

Most common eye muscle N involved w/ herpes zoster ophthalmicus

4th nerve
- it shares nerve sheath w/ ophthalmic division of trigeminal

53

What type of CN 3 palsy do you get w/ diabetics?

Vessel affected is usually deep in 3rd nerve
- not superficial so pupillary constriction usually ok

Can get pain in and about eye w/ damaged 3rd N

54

Oculomotor fiber aberrant regeneration - what should you suspect?

Usually due to lesions that chronically compress 3rd nerve

Suspect:
Aneurysms
Cholesteatomas
Neoplasms

55

Internuclear ophthalmoplegia

MLF syndrome

On attempted conjugate lateral gaze AWAY from side of lesion, get nystagmus
- nystagmus (Fast component) is directed temporally to lesion side

56

1 1/2 syndrome

L MLF and L abducens nucleus damaged

Left gaze, both eyes still in center
Right gaze (away from lesion), get nystagmus to L

57

Ocular bobbing

Rapid down deviation of both eyes followed by SLOW upward conjugate eye mvmts

Involuntary mvmt usually develops w/ pontine damage (eg pontine glioma)

Damage to cerebellum also gets this

58

Optokinetic nystagmus

Should be elicitable in normal pts

If nystagmus is less obvious on rotating drum in given direction, pt may have PARIETAL lesion responsible for asymm. response

59

Does orbital cellulitis cause vision loss?

NO! Not usually

Will c/o orbital pain, proptosis, pain with eye mvmts

CT to see extent of cellulitis

60

Cavernous sinus thrombosis

Proptosis
Pain
Retina changes
VA affected b/c venous drainage not ok

61

Adie tonic pupil

Tonically dilated pupil

Usually seen in healthy young women

Can occur alone or w/ absent tendon reflexes

If unilateral --> suspect local trauma to eye
If bilateral --> suspect drug use

Probably due to degen of ciliary ganglia

Usually benign phenoenon

62

Usher syndrome

Hearing loss + visual impairment

Retinitis pigmentosa
Defective inner ear

63

Most common cause of acute monocular blindness

Ischemic optic neuropathy
- usually due to occlusion of posterior ciliary A (branch of ophthalmic artery)
- not assoc w/ carotid disease

Sudden painless loss of vision in 1 eye

VF have inferior altitudinal defect w/ involvement of central vision --> loss of acuity
- opposite eye can get affected soon after

RIsk factors:
HTN
DM

Need to exclude GCA

64

How can you tell when you have increased ICP on funduscopy?

Veins normally pulsate

Will not pulsate with increased ICP

65

What is best sensory test for afferent pupillary defect?

Swinging flashlight

66

What can give you blurry vision?

Papillitis
Diplopia
Cataracts
Papilledema/Optic nerve stuff
Macular degeneration
Homonymous hemianopia

67

For person w/ Horner's, do you see a bigger difference in pupil reflex in dark or light?

Dark

68

How do you monitor retina during electonystagmography studies?

Retina is negatively charged in comparison with cornea -- creates a dipole to monitor

69

Painful Horner's after vigorous activity?

Carotid dissection

70

PIgmentary degeneration of retina

can occur with infections (congenital toxo, CMV)

Part of hereditary metabolic disorder (RP)

71

opsoclonus

irregular jerking of eyes in all directions

72

Sudden loss of vision
Onset of floaters
Fundus is difficult to visualize

Vitreous hemorrhage

#1 cause of vitreous hemorrhage is diabetic retinopathy

73

Afferent pupillary defect is very specific for...

Optic nerve problem

74

What aneurysm gives you CN 3 palsy?

Posterior communicating cerebral artery

75

Most common cause of 4th nerve palsy

Head trauma

76

#1 cause of cherry red spot of fovea?

Central retinal artery occlusion

There is ischemia of retina - becomes pale - and now can see choroid clearly underneath macula

77

Circulation of eye

Chroidal circulation

Retinal arteries

78

Most common cause of viral conjunctivitis is

Adenovirus.

Infection often has systemic sx

79

Ocular migraine sx

Binocular!

80

A 3-year-old female is brought to your office for a health maintenance examination, and her father expresses concern about her vision. Her visual acuity is 20/20 bilaterally on a tumbling E visual acuity chart. With both eyes uncovered during a cover/uncover test, the corneal light reflex in the right eye is medial to the pupil when focused on a fixed point, but the light reflex in the left eye is almost centered in the pupil. When the left eye is covered, the right eye moves quickly inward to focus on the fixed point, and the corneal light reflex is centered in the pupil. When the left eye is uncovered, the right eye returns to its original position. When you cover the right eye, no left eye movement is noted. Which one of the following is the most likely diagnosis? (check one)
A. Strabismus
B. Amblyopia
C. Cataract
D. Esotropia
E. Heterophoria

Strabismus is an ocular misalignment that can be diagnosed on a cover/uncover test when the corneal light reflex is deviated from its normal position slightly nasal to mid-pupil. The misaligned eye then moves to fixate on a held object when the opposite eye is covered. The eye drifts back to its original position when the opposite eye is uncovered. Amblyopia is cortical visual impairment from abnormal eye development-most often as a result of strabismus. Cataract is a less frequent cause of amblyopia. Esotropia is a type of strabismus with an inward or nasal deviation of the eye that would be evidenced by a corneal light reflex lateral to its normal position. (The outward eye deviation seen in this patient is exotropia.) Heterophoria, or latent strabismus, does not cause eye deviation when both eyes are uncovered.

81

Age related macular degneration
- predisposition
- risk factors

occurs more frequently in light-skinned individuals than in dark-skinned individuals.

Risk factors include smoking and hypertension

82

Ophthalmopathy of Grave's may get worse when treated w/ what?

Radioactive iodine

83

Ophtho side effect of sildenafil

Non-arteritic anterior ischemic optic neuropathy (NAION) is a very rare but serious condition which may occur in men taking sildenafil.

It causes restriction of blood flow to the optic nerve and can result in permanent blindness.

84

Bitot spots

Dry silver-gray plaques on bulbar conj

Seen in vit A deficiency

85

Tx bacterial conjunctivitis

Sulfonamide drops

86

Binocular fixation present at what age in kids?

3-4 months

87

NOrmal acuity in newborn is...

20/200 - 20/400

88

Coloboma

Defect of lid that can range from small indentation to large cleft

Can lead to ulceration from excessive drying

89

Epicanthal folds

Folds of skins on nasal side of eye

Usually more prominent at birth and recede with time

Responsible for pseudostrabismsus by making eyes appear closer together

90

Blepharitis

Inflammation of lid margins

91

Most common causes of neonatal conjunctivits

Chlamydia
Gonorrhea

92

Conjunctivitis

Tearing
COnjunctival injection
Lid edema
Discharge

93

Dacryostenosis

Caused by congenital lacrimal duct obstruction

Usually unilateral

CLear d/c

Spontaneous resolution by age 1

94

Strabismus

Misalignment of eyes

Deviations can be:
- convergent (esotropia)
- divergent (exotropia)
- results from abnormal innervatino of muscles from supranuclear nerve

95

Dx strabismus

Hirschberg test - looking for corneal reflex

Cover test

96

Amblyopia

decrease in acuity 2/2 unclear image falling on retina

Usually 2/2 strabismus or by opacity in visual axis

97

Dx corneal abrasions

Slit lamp of eye under blue filtered light after instillation of fluorescein

Tx - topical abx

98

Periorbital cellulitis

No true orbital involvement

ONly eyelids and surrounding tissues involved

Eye mvmts normal

99

Follicles + inflammatory changes in conjunctiva of eye

Neovascularization in cornea

Immigrant

Trachoma 2/2 C. trachomatis serotype A-C

Can also cause nasal discharge as it moves

Tx: Topical tetracycline or oral azithromycin