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LMCC > Ophtho > Flashcards

Ophtho Flashcards

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1
Q

Most common signs of retinoblastoma

A

Leukocoria

Esotropia

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2
Q

Corneal light reflex in strabismus

A

No response in affected eye

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3
Q

Red reflex in strabismus

A

Red reflection is MORE intense from deviated eye

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4
Q

Amblyopia

A

Eye fails to achieve normal visual acuity even with prescription glasses or contact lenses
Occurs in up to 1/2 of younger children with strabismus

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5
Q

Myopia

A

Nearsightedness

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6
Q

Hyperopia

A

Farsightedness

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7
Q

Internuclear ophthalmoplegia

A

Caused by lesion of MLF in mid-pons
Disorder of horizontal eye movements: affected eye unable to ADduct, contralateral eye able to ABduct but with nystagmus
Unilateral (commonly caused by stroke)
Bilateral (commonly caused by demyelning disorder ie. MS)
Ex. Right MLF lesion causes Right INO (unable to adduct right eye when looking left)

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8
Q

Giant cell arteritis presentation

A 
Unilateral vision loss (often) 
Headache
Jaw claudication
Scalp tenderness
Constitutional symptoms
High ESR/CRP
RF: age, female, smoking, low BMI, PMR
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9
Q

GCA tx

A

1st step: high dose pred for months-years (usually switched to immunosuppression)

  • Temporal artery biopsy
  • Urgent referral to ophtho and rheum
  • If left untreated, will involve other eye within 2 weeks
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10
Q

Optic neuritis presentation, etiology

A 
Young females
Reduced colour vision
Pain with EOM
Visual field defect
Often due to MS
May be idiopathic
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11
Q

Optic neuritis tx

A

Refer to ophtho and neuro
MRI MS protocol
High dose IV steroids

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12
Q

Retinal vascular occlusion: Arterial occlusion etiology, fundoscopy

A

May be caused by embolism (stroke workup), inflammation (GCA, vasculitis)
Fundoscopy: retinal pallor due to ischemia, cherry red spots (fovea appears red compared to surrounding retina)

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13
Q

Retinal vascular occlusion: Venous occlusion etiology, fundoscopy

A

Older pt with microvascular dz, atherosclerosis (arteries squish the veins)
Younger pt with hyperviscosity due to polycythemia, myeloma, etc.
Fundoscopy: cotton wool spots (areas of ischemia, hemorrhage)

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14
Q

Retinal detachment

A

Black curtain, flashes of light (photopsia), floaters
Macula on –> emergency, needs to be fixed before macula comes off; pinhole correction means NO fovea involvement
Macula off –> not an emergency anymore; no pinhole corection means fovea involved, will not be able to regain vision

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15
Q

Vitreous detachment

A

Normal part of aging
Floaters and flashes
All need dilated retinal exam to rule out retinal tear/detachment within a few days
No good tx for floaters

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16
Q

Lesion of optic nerve

A

Ipsilateral monocular vision loss

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17
Q

Lesion of optic chiasm

A

Bitemporal hemianopsia

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18
Q

Lesion at optic tract

A

Contralateral homonymous hemianopsia

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19
Q

Cataracts symptoms

A 
Blurred vision
Glare 
Difficulty seeing in low light 
Loss of contrast sensitivity 
Loss of ability to discern colours 
Change in refractive status
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20
Q

Cataracts surgical guidelines

A

Visual acuity 20/50 or worse WITH glasses
Visual acuity 20/40 or better but with significant visual impairment
Always up to the patient, except
Driving (must be 20/50 or better)
Angle closure glaucoma

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21
Q

Macular degeneration: dry type

A

More common
slow progressive atrophy of RPE and photoreceptors
Characterized by Drusens in macula
Tx: Smoking cessation, vitamins

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22
Q

Macular degeneration: wet type

A

RPE detachment and choroidal neovascularization
Leaky vessels
Tx: Anti-VEGF injections

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23
Q

Symptoms of macular degeneration

A

Progressive and bilaterall loss of central vision, metamorphopsia, distortion of vision, scotoma or blind spot

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24
Q

Open angle glaucoma

A

Chronic decreased outflow or increased production of aqueous fluid
Increased cup-to-disc ratio
Slow loss of peripheral vision, asymptomatic
Tx: Lower IOP with drops (prostaglandins ie. latanoprost better than beta blockers ie. timolol), laser or surgery as last line

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25
Cataract
Opacity of lens
26
Closed angle glaucoma
Mechanical blockage of fluid flow to anterior chamber, closing angle between lens and cornea N/V, headache, acute changes in vision, pupil fixed in mid-dilation IOP up to 40-60
27
Normal IOP
10-22mmHg
28
Closed angle glaucoma tx
``` Emergency Eye drops (ie. timolol) IV diamox (carbonic anhydrase inhibitor to decrease fluid production) IV mannitol Check kidneys! Laser peripheral iridotomy ```
29
Diabetic retinopathy on fundoscopy
``` Nonproliferative: Microaneurysms Retinal hemorrhage Cotton wool spots Proliferative (worse): ischemia of retina with neovascularization Any stage: Macular edema ```
30
Diabetic retinopathy tx
Control diabetes Non-proliferative - no tx Macular edema - anti-VEGF Proliferative - laser photocoagulation, anti-VEGF injection, vitrectomy
31
Emmetropia
No refractive error
32
Astigmatism
Light rays not refracted uniformly due to non-spherical surface of cornea or non-spherical lens May cause blurry vision, squinting, headaches
33
Anisometropia
Difference in refractive errors btwn eyes | 2nd most common cause of amblyopia in children
34
Preseptal cellulitis tx
Systemic abx to cover S. aureus, Strep, H. influenza if child Ie. Amox clav
35
Septal cellulitis tx
Admit Blood cultures x2 Orbital CT IV abx (CTX + Vanco x 1wk)
36
Hordeolum
Stye Acute inflammation of eyelid gland (Meibomian, glands of Zeis or Moll) Infectious agent typically S. aureus Tx: Warm compresses, lid care, gental massage)
37
Chalazion
Chronic granulomatous inflammation of Meibomian gland often preceded by internal hordeolum NOT infectious case
38
Blepharitis
Inflammation of lid margins S. aureus, seborrheic, meibomian gland dysfunction Warm compresses, lid massage, lid washing, topical/systemic abx as needed
39
Viral conjunctivitis common culprit
Adenovirus
40
Bacterial conjunctivitis common causes
``` S. aureus S. pneumo H. influenza M. catarrhalis N. gonorrhoeae, C. trachomatis in neonates ```
41
Most common cause of bacterial conjunctivitis in neonates
C. trachomatis
42
Leading infectious cause of blindness in world
Trachoma
43
Trachoma tx
Oral azithro and topical tetracycline
44
Episcleritis vs scleritis
Phenylephrine drop --> reexamine 10-15min later | Episcleritis = episcleral vessles blanch with phenylephrine
45
Corneal abrasion tx
Topical abx Topical NSAIDs Cycloplegic Patch
46
Corneal ulcer
Corneal opacity stains with fluorescein Seidel test: Fluorescein under cobalt blue filter --> leaking penetrating lesions Tx: URGENT referral to ophtho, culture prior to tx, topical abx q1h
47
Herpes simplex keratitis
Usually HSV1 Dendritic lesion with terminal end bulbs in epithelium that stains with fluorescein Tx: Topical or systemic antiviral, NO STEROIDS initially (only done by ophtho)
48
Herpes zoster ophthalmicus
CNV1 | Tx: Oral antiviral immediately, topical steroids/cycloplegia as indicated, erythromycin ointment if conjunctiva involved
49
Hutchinson's sign
If tip of nose is involved, globe will be involved in 75% Of cases
50
Most common cause of reversible blindness worldwide
Cataracts
51
Most common surgical technique for cataracts
Phacoemulsification
52
New or markedly increase in floaters or flashes of light require dilated fundus exam to R/O
Posterior vitreous detachment/retinal detachment
53
Retinal artery occlusion hallmark on exam
Cherry red spot atcentre of macula | also retinal pallor, cotton wool spots, cholesterol emboli
54
Retinal artery occlusion presentation
Sudden, painless, severe monocular loss of vision
55
Retinal artery occlusion tx
OCULAR EMERGENCY Needs to attempt to restore blood flow within 2h Ocular massage and high flow O2 Decrease IOP (topical BB, IV acetazolamide, IV mannitol)
56
Central retinal vein occlusion hallmark on exam
Blood and thunder: | Diffuse retinal hemorrhages, cotton wool spots, venous engorgement, swollen optic disc, macular edema
57
Leading cause of irreversible blindness in western world
Age related macular degeneration
58
Most common cause of age related macular degeneration
Dry/Non-exudative/non-neovascular
59
Characteristic finding of dry AMD
Drusen - yellow/white deposits btwn RPE and BRuch's membrane
60
Characteristic finding of wet AMD
Chorionic neovascularization
61
Classic clinical feature of AMD
Variable degree of progressive central vision loss | Metamorphsia
62
Wet AMD tx
Intraveitreal injection of anti-VEGF
63
Pressures > ___ increase risk of developing glaucoma
21mmHg
64
Primary open angle glaucoma
Resistance from trabecular meshwork Earliest signs are optic disc changes (Increased C:D ratio) Slow progressive irreversible loss of peripheral vision
65
Primary open angle glaucoma tx
Increase aqueous outflow (topical cholinergics, topical prostaglandins, topical alpha adrenergics) Decrease aqueous production (topical beta blockers, topical and oral carbonic anhydrase inhibitors, topical alpha adrenergics) Surgery
66
Acute angle-closure glaucoma
``` Fixed mid-dilated pupil RF: hyperopia, pupil dilation, asian female, >70yo, mature cataract RED PAINFUL EYE Unilateral >40mmHg IOP ```
67
Acute angle closure glaucoma tx
Beta-blockers (timolol)/miotics (pilocarpine - increases outflow) Diamox (Carbonic anhydrase inhibitor to decrease aqueous production) Hyperosmotic agents (oral glycerine, IV mannitol) Laser iridotomy is definitive
68
Highly specific sign of neurosyphillis
Argyll-Robertson pupil (bilateral small pupils that constrict with accommodation but NOT to light reflex)
69
CN III palsy
Eye deviated down and out with ptosis | Pupillary dilation
70
Most common cause of relative afferent pupillary defect
Optic neuritis
71
Relative afferent pupillary defect
Impairment of direct pupillary response to light caused by lesion in visual afferent (sensory) pathway anterior to optic chiasm Pupils DILATE in response to rapid swinging of light from unaffected to affected eye Cannot have RAPD in both eyes
72
Most common malignancy on eyelid
BCC
73
Most common primary intraocular malignancy in adults
Uveal melanoma
74
Most common intraocular malignancy in adults
Metastases
75
Kaposi's sarcoma secondary to
Human Herpes Virus 8
76
Diabetic retinopathy
Most common cause of blindness in young people in NA Non-proliferative --> Proliferative Tx: DM/HTN control, anti-VEGF injections, vitrectomy if non-clearing vitreous hemorrhage and tractional RD
77
Optic neuritis tx
IV steroids with taper to oral form | Can't start oral form in isolation as this increases likelihood of eventually development of MS
78
Heterotropia vs heterophoria
Deviation NOT corrected by fusion mechanism in heterotropia | Deviation IS corrected by fusion mechanism in heterophoria (ie. not seen when pt is focusing with both eyes)
79
Most common primary intraocular malignancy in children
Retinoblastoma
80
Strabismus tx
Glasses Occlusion therapy Sx Botox
81
Suspected globe rupture initial management
``` CANT CT orbits Ancef +/- Aminoglycoside IV NPO Tetanus status ```
82
Alkali or acid burns worse for eyes?
Alkali
83
Managing chemical burn
``` Irrigate immediately DO NOT attempt to neutralize Cycloplegic drops to decrease iris spasm and prevent secodnaey glaucoma Topical abx and patching Ophtho may rx topical steroids ```
84
Common mydriatics
Dilate pupils 2 classes: 1. Cholinergic blocking (tropicamide) - dilation plus cycloplegia (loss of accomodation) 2. Adrenergic stimulating (ie. phenylephrine) - stimulate pupillary dilatory muscles, no effect on accomodation
85
CMV retinitis
Full thickness retinal inflammation causing edema and scarring --> blurred vision, floaters, photopsia --> scarring and possible retinal detachment Think about in immunocomprised pt ie. HIV (reactivation of latent dz) Fundoscopy: Yellow-white fluffy hemorrhagic lesions along vasculature Tx: oral antivirals
86
Hallmark signs of trachoma
Follicular conjunctivitis and pannus formation (neovascularization) in cornea

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