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ctjghjkbgf > Ophtho > Flashcards

Ophtho Flashcards

1
Q

Components of physical exam for red eye

A

Visual acuity, pupil shape and reactivity, gross appearance of sclera and conjunctiva, EOM, palpation of preauricular nodes + fluorescein and slit lamp exams
Presence of contact lenses

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2
Q

Common DDx of red eye (list 8)

A
  • Conjunctivitis: infectious (viral including HSV), bacterial, chlamydial
  • Allergic or seasonal conjunctivitis
  • Chemical conjunctivitis (or other physical agents such as smoke)
  • Systemic disease (iritis, scleritis-may have tender red eye with bluish hue) (JIA, KD, IBD, CF, status post-radiation, BMT, SJS)
  • Trauma: corneal or conjunctival abrasion, hyphema, traumatic iritis, FB, subconjunctival hemorrhage, traumatic glaucoma, noxious material
  • Dry eye syndromes
  • Abnormalities of lids and/or lashes: blepharitis, stye or chalazion, periorbital or orbital cellulitis
  • Contact lens problems: infectious keratitis (corneal ulcer), allergic conjunctivitis, poor fit, overwear, corneal abrasion
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3
Q

Ophtho findings in Kawasaki disease

A

bulbar conjunctivitis, limbal sparing, minimal or no discharge

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4
Q

Symptoms and signs of iritis

A

Red eye, headache, pain, photophobia, conjunctival injection, vision blurring, hypopyon

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5
Q

Name 2 conditions that present with pseudomembranes

A

Adenovirus (epidemic keratoconjunctivitis) and SJS

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6
Q

Clinical findings of adenovirus conjunctivitis

A

pseudomembrane, preauricular nodes, tearing, usually bilateral, can see photophobia, sandy foreign-body sensation

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7
Q

Which cranial nerves control the extra-ocular movements

A

LR-6 (lateral rectus), SO-4 (superior oblique), rest CN3

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8
Q

List 6 life-threatening causes of strabismus

A

intracranial mass, elevated ICP, myasthenia gravis, orbital tumor, orbital cellulitis, head trauma, meningitis, neoplastic infiltrate of EOM, superior orbital wall fracture, retinoblastoma causing vision loss

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9
Q

Findings in Horner syndrome

A

mild ptosis, miosis (constricted), ipsilateral anhidrosis

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10
Q

How to determine which pupil is abnormal in anisocoria?

A

a. Bigger difference in a bright room (pupils normally constrict) – failure to constrict –> large pupil is abnormal
b. Bigger difference in dark room (pupils normally dilate) – failure to dilate –> smaller pupil is abnormal
c. Same difference in dark or light room = physiologic anisocoria

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11
Q

Emergency causes of visual disturbances (list 3)

A

alkali or acid burns, central retinal artery occlusion, ruptured globe

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12
Q

Toxicologic causes of visual disturbances

A

methylene glycol, hydrocarbons, quinine, mercury, quinidine, digoxin

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13
Q

What is a “footballer’s migraine”?

A

total blindness after mild head trauma, with normal physical exam, lasts minutes-hours = cortical blindness

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14
Q

How does central retinal artery occlusion (CRAO) present? And what are some predisposing conditions?

A

Sudden, painless loss of vision in one eye (with pale white optic nerve) – traumatic or embolic (increased risk in vasculitis, sickle cell, severe HTN)

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15
Q

List 6 causes of acute diplopia

A 
Blowout fractures
Poisoning
CNS pathology (tumor, bleed, IIH)
shunt malfunction
arnold-chiari malformation
myasthenia gravis
head trauma
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16
Q

Clinical findings of a ruptured globe

A

Tear drop pupil (apex points to the direction of the rupture), 360 subconjunctival hemorrhage, enopthalmos (posterior displacement of eye in the socket) +/- hyphema

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17
Q

What complication of ruptured globe leads to poor visual outcome?

A

Endophthalmitis: infection of anterior and posterior segments of the eye, leads to poor visual outcome

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18
Q

Management of a ruptured globe?

A

Stop eye exam, (no eye drops), shield the eye, pain control, antiemetics, elevated head of bed, place eye shield and immediate referral to ophtho; consider broad spectrum antibiotics

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19
Q

Signs and symptoms of a blowout fracture

A

restriction EOM
enopthalmos (eye sunken in socket)
infraorbital anesthesia (infraorbital nerve)
diplopia
step-off deformity
subcutaneous emphysema
may see proptosis if orbital hemorrhage present (can compress optic nerve)
retrobulbar hemorrhage (pain, proptosis, vision loss from central retinal artery occlusion and may need urgent canthotomy)

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20
Q

Gold standard for imaging in suspected blowout fracture?

A

CT scan orbit with axial and coronal views and the brain especially if orbital roof fracture suspected

21
Q

Which eyelid lacerations require ophtho consult?

A
  • full-thickness perforation of lid
  • ptosis
  • involvement of lid margin
  • damage to tear drainage system
  • tissue avulsion
  • eyeball injury
22
Q

How to make diagnosis of corneal abrasion?

A
  1. Dx by fluorescein + direct visualization with blue light
  2. Tetracaine 0.5 % : diagnositic ; if pain relieved then there is an ocular surface problem (conjunctiva or cornea)
  3. Test vision
23
Q

Which corneal abrasions require ophtho referral?

A

If pain or FB sensation continues for more than 2-3 days, increasing pain, increasing redness, contact lens wearers, large abrasion over visual axis, hx of ocular herpes

24
Q

Management of corneal abrasion?

A
  • Do not patch (doesn’t help healing or pain control)
  • R/O foreign body
  • Lubricating antibiotic ointment (polytrim, erythromycin, bacitracin, vigamox) for 3-5 days; pain control with NSAID/tylenol. NO topical anesthetics

Larger corneal abrasion and those involving visual axis = should see ophtho within 24 hours

25
Q

Which bacteria is involved in bacterial keratitis in contact lens wearers

A

Pseudomonas

26
Q

Complications seen in hyphema (2)

A

1) rebleeding within first 5 days (especially in sickle cell)
2) increased intraocular pressure –> glaucoma

27
Q

Management of hyphema

A
  • Urgent ophtho consult
  • Shield the eye (not a patch)
  • bedrest with HOB to 45 degrees
  • cycloplegic +/- corticosteroid eye drops
  • avoid NSAIDs
  • sometime admitted to hospital for observation
28
Q

How does traumatic iritis present?

A

Inflammation in anterior chamber 1-3 days after trauma – eye pain, photophobia, redness (ciliary flush), visual loss, constricted pupil on affected side

29
Q

Treatment of traumatic iritis?

A
  • Ophtho consult – often associated with other ocular injuries
  • Tx: dilating eye drops, topical steroids
30
Q

Clinical findings of orbital cellulitis?

A

Decreased or painful EOM, proptosis, decreased vision, papilledema, toxic and highly febrile

31
Q

Complications of orbital cellulitis

A

subperiosteal abscess, orbital abscess, CSVT, brain abscess

32
Q

Which bacteria cause conjunctivitis?

A

strep pneumo, H. influenzae, S.aureus, Moraxella catarrhalis (chlamydia and gonorrhea in neonates)

33
Q

How does gonococcal conjunctivitis present in neonates? Management?

A

sudden, severe, ++pus and exudate, swollen eyelids. Can cause corneal ulceration and perforation -> blindness. Tx: hospital admission, IV ceftriaxone, ophtho consult, saline ocular lavage hourly, topical erythromycin ointment.

34
Q

Fluorescein pattern seen in HSV keratitis?

A

Dendrites

35
Q

Management of conjunctivitis?

A

Symptomatic relief for all cases: artificial tears, cool compresses
Topical antibiotics for bacterial causes (erythromycin, trimethroprim/polymyxin B) – not required for viral causes
See ophtho if no improvement within 1 week
Cultures of purulent fluid in neonates

36
Q

Red flags for conjunctivitis?

A

reduced visual acuity, significant pain/photophobia, corneal opacities, FB sensation, *contact lens wearers

37
Q

Management of ocular chemical injuries?

A

o Standard IV set, maximum flow rate, across the eye from medial to lateral. Can use Morgan lens attachment. Irrigate for 2 L or 20 minutes for alkali (1L or 5 minutes for acids). Also evert the upper lid and irrigate in that position.
o Check pH afterwards, aim for 6.5-7.5, equal between both eyes (if only 1 eye was exposed) – repeat pH checks a few times over 30 minutes to ensure it remains stable
o Examine cornea and conjunctiva with fluorescein afterwards
o Consult ophtho

38
Q

Which ocular chemical injury is worse - alkali or acids?

A

Alkali

39
Q

Tx of a stye

A

eyelash scrubs daily, warm compressed 4X/day, topical abx rarely needed, incision and curettage by ophtho if non-resolving after 4-6 weeks.

40
Q

Eyelid swelling - DDx

A

Acute - stye (external hordeolum)

Chronic - chalazion

41
Q

Complications of dacrocystitis

A

periorbital or orbital cellulitis, sepsis, meningitis

42
Q

Steps to finding a “lost contact lens”

A

look for fine line on the sclera, evert the lids, apply topical anesthetic, patient looks down, sweep over upper fornix gently with moistened cotton-tip applicator. Can use fluorescein drops which would permanently dye the contact lens.

43
Q

Classic triad of infantile glaucoma?

A

tearing, photophobia, blepharospasms (eyelid squeezing)

44
Q

List 5 findings of congenital glaucoma

A
  1. Excessive tearing (usually bilateral)
  2. Rhinorrhea
  3. Photophobia
  4. Corneal clouding
  5. Buphthalmos (asx eye size)
  6. Increased IOP
  7. Abnormal red reflex
45
Q

List 4 complications of congenital glaucoma

A 
Ambylopia
Vision loss/blindness
Strabismus
Large refractive error
Myopia
Astigmatism
Corneal scarring
46
Q

List 4 serious, major causes of sudden vision loss

A 
Optic Neuritis
Central Retinal artery occlusion (CRAO) or central retinal vein occlusion (CRVO)
Stroke
Complicated Migraine
Retinal detachment
Ruptured globe
Occipital contusion
47
Q

5 causes of tramatic acute red /painful eye

A 
Corneal abrasion
Traumatic Iritis (does not present for 24 to 72 hours after blunt trauma to the eyeball)
Hyphema
Subconjunctival hemorrhage
Foreign body
Chemical conjunctivitis
48
Q

Kid comes in with unilateral red eye, watery discharge and pre-auricular nodes. what is the most likely cause

A

Herpes keratoconjunctivitis

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