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Flashcards in Optho Deck (11):
1

CN III Palsy

"Down and out"

Blown pupil + ptosis

If pupil blown: likely aneurysm/tumor compressing as parasympathetic fibers run on outside of nerve sheath. If no blown pupil, likely diabetic/vasculopathic/ischemic.

Always get CT/CTA

2

CN VI Palsy

Cross eyed (stuck in medial gaze) as 6 controls Lateral rectus

Often happens with increased ICP

CT if HA/papilledema to r/o IICP, otherwise no imaging, outaptient f/u

3

CN IV Palsy

Upward shift on medial gaze and torsional component on lateral gaze.

Can happen with trauma.

CN IV is the only CN that comes off back of brainstem and travels a long way. Controls superior oblique.

No imaging needed if isolated. Outpatient f/u.

4

Bacterial Conjunctivitis Treatment

Children: Eryrthromycin 5 mg/g opthalmic ointment, 1/2" ribbon lower lid QID X 5-7d

Adults: Trimethoprim-polymyxin B 0.1%-10,000 units/mL (Polytrim) eye drops 1-2 drops QID X 5-7d

Contact Lens Wearers: Vigamox 1-2 drops QID X 7d or Ciloxan 0.3% 1-2 drops QID + ointment (3.5 g) 1/2 inch ribbon at bed-time

5

Allergic Conjunctivitis Treatment

Age >2: Pataday 1 drop once daily (antihistamine). May use indefinitely. Start 24-48h before anticipated exposure.

6

Determination of Visual Acuity

1) The visual acuity is determined by the smallest line a patient can read with one half of the letters correct. The number of incorrect letters is listed after the visual acuity as follows: 20/x-y (e.g., 20/40-2)

2) If <20/200, finger counting at 1 m, hand motion at 0.5 m then light perception

7

Normal VA for children

  • 6 mo - 3 y = track object
  • 3-5 = 20/40 with 1 line difference between eyes
  • >5 = 20/25, no difference between eyes

8

Opthalmia Neonatorum

  • conjunctivitis in neonates
  • rapid Gram stain of DC
  • chemical
    • within first 24h (after prophylaxis with erythromycin at birth)
    • bilateral, watery DC, -ve Gram stain
    • watchful waiting x 48h
  • gonococcal
    • usually at 2-7 days
    • intense erythema, chemosis, purulent DC
    • admit, IV Abx, often pan-culture with LP
  • chlamydial
    • usually 7-14 days
    • purulent DC, redness of palpebral conjunctiva
    • often also have pneumonia
    • PO + topical erythromycin
    • can often DC home with 24h f/u
  • other bacterial
    • can tx as outpatient except H. flu
  • viral
    • HSV
    • full septic workup + IV Acyclovir

9

Nasolacrimal Duct Problems, Peds

Dacryostenosis

  • most resolve by 12 mo --> refer to optho if not resolved
  • yellow DC/tears and fluoro pooling with no conjuctival irritation
  • gentle massage downward motion over nasolacrimal duct QID

Dacryocystitis/Dacryoadenitis

  • usually post-URI
  • purulent DC when pressing on NL duct (cystitis)
  • redness + tenderness
  • may lead to periorbital cellulitis
  • culture
  • often need IV cefuroxime or ancef and brief admission but may start with PO Keflex

Dacryocele

  • small bluish palpable mass in NL duct --> urgent optho referral for eventual marsupialization

10

Features of Orbital Cellulitis

  • Fever
  • pain with EOM
  • photophobia
  • RAPD
  • chemosis

11

Diplopia Review

Evernote "Eye EM"