Optho Flashcards
Child cannot open eyes because closed by pus discharge, you clean it and see injected conjunctivae, normal EOM, normal visual acuity, no edema/redness of lid. Treated with cipro drops but no resolution after 3 days. Next step:
a. continue cipro drops
b. D/C cipro drops and change to fucidin
c. Admit for iv antibiotics
D/C cipro drops and change to fucidin –? Danielle - best as per Dr. Leung
I think that if there is no improvement after 3 days, I would change antibiotics (so probably b) and not just continue on the same cipro drops. No need for IV Abx unless there is a progression to orbital cellulitis. I must say that cipro is a broader spectrum than fucidin, so i probably would realistically go with something like Moxifloxacin
Teenager wears contact lenses. Develops purulent conjunctivitis. When you clear away the purulent debris you note you has conjunctivitis but normal EOM and normal vision. You prescribe topical cipro drops and see him in 36 hours. At this time his exam is unchanged. What would you do at this point?
a. Change to another topical antibiotic
b. Refer to ophthalmology urgently
c. See him again in 48 hours to re-assess
DO you have to see all people with contacts
Refer to ophthalmology urgently
People are much more at risk of corneal ulcers/ disease with CL use vs no CL use. There would be no way for you to judge that without a slit lamp and not all red eyes with CL are infectious so if your initial management does not seem to produce the results expected,
A 1 month-old baby presents to your office with 24 hours of unilateral eye swelling and discharge. They appear like the following image. What is the diagnosis?
a) Dacryocystitis
b) Orbital Cellulitis
c) Bacterial conjunctivitis
d) Neuroblastoma
dacrocystitis
Dacryocystitis is the inflammation or infection of the nasolacrimal apparatus that presents with acute-onset erythema, edema, warmth, and tenderness over the lacrimal sac. Other common signs and symptoms are fever, poor feeding, altered behavio
If possible, purulent eye discharge should be sent for culture to guide definitive antimicrobial therapy. Most common pathogens are α-hemolytic streptococcus, Staphylococcus epidermidis, and Staphylococcus aureus. However, up to 25% may be caused by gram-negative bacteria, Escherichia coliand Haemophilus influenzae being most common. Rarely, the pathogen can be an anaerobe or fungus.
Which is true of ophthalmia neonatorum
a) The most common organism is Neisseria Gonorrhea, but it is now almost always resistant to the prophylaxis, therefore prophylaxis is not indicated
b) Ophthalmia neonatorum can lead to significant eye injuries and blindness, therefore antibiotic prophylaxis is indicated
c) The most efficient way of preventing it is through screening and treatment of pregnant women rather than the current prophylaxis.
c) The most efficient way of preventing it is through screening and treatment of pregnant women rather than the current prophylaxis.
gonorrhea and chlamydia infection, and treatment and follow-up of those found to be infected. Mothers who were not screened should be tested at delivery. Infants of mothers with untreated gonococcal infection at delivery should receive ceftriaxone.
Kid with orbital cellulitis of the right eye being treated with ceftriaxone. Next day lethargic and swelling/erythema of the left eye develops. What do you do?
Add vancomycin
Consult surgery to drain an orbital abscess
MRI brain
mri brain
CVST vs orbital cellulitis
Typically, patients who have cavernous sinus thrombosis have acute or slowly progressive proptosis, periorbital edema, and ophthalmoplegia. Loss of vision and meningismus may be late findings.
Who is most at increased risk of glaucoma?
a. Infant who had congenital cataracts surgically removed
b. Infant with cystinosis
c. A child with trisomy 21 who has Brushfield spots
d. A child who has had laser surgery for myopia
Aphakia — Children who have undergone cataract surgery are at risk for developing secondary open-angle or angle-closure glaucoma [38]. Aphakic glaucoma is the second-most common cause of glaucoma in children (after primary infantile glaucoma), ac
10 yo M with bilateral conjunctivitis which he describes as sandpaper foreign body feeling, pseudomembranes are present. Which of the following is the most likely diagnosis?
a. Bacterial conjunctivitis
b. Infectious keratitis
c. Adenovirus keratoconjunctivitis
ADENO KERATOCONJUNCTIVITS
-bacterial conjunvitis dont have any FB sensation
Pseudomembranous conjunctivitis - layer of fibrin-rich exudate is superficial and can often be stripped easily, leaving the surface smooth. Occurs with many bacterial and viral infections including staphylococcal, pneumococcal, streptococcal, or chlamydial conjunctivitis, and in epidemic keratoconjunctivitis. Also found in vernal conjunctivitis and in Stevens-Johnson disease
Teenager with meningitis caused by tuberculosis. What medication will require ophthalmology assessment?
a. pyrazinamide
b. ethambutol
c. isoniazid
d. Rifampin
ethambutol - optic nerve toxivity
for longer than 2 months or receiving higher doses > 25mg/kg should have monthly eye examination including colour discrimination and visual acuity.
Ethambutol, linezolid, ethionamide, isoniazid and clofazimine produce eye toxicity.
- Cataracts picture above from boy immigrated from India. What is the most likely cause?
a) Rubella
b) Galactosemia
c) Idiopathic (⅓ of them are idiopathic)
d) Cystinosis
rubella
Although rubella is the most common infectious cause of congenital cataracts, other congenital infections, such as cytomegalovirus, varicella, herpes simplex, toxoplasmosis, and syphilis, may cause them
. 4 year old with loss of vision, bilateral eye injection, iris fused (sounded like uveitis): treatment ?
a) oral steroids
b) topical steroids
topical steroids
Hemangioma over eye, what do you want to do first?
a) Consider starting propranolol
b) Call optho
c) Wait 2 weeks then reassess
call optho=
periorbial hemangiomas include: compression of the globe, obstruction of the visual axis and extension into the retrobulbar space
Early optho assessment is necessary to determine how urgently intervention is required
Amblyopia is the most common serious side effect:
When is it indicated an eye screening in newborn?
A. Newborns <31 weeks and <1250gr
B. Newborns < 1500gr
C. Patients who had received Indo and ibuprofen treatment and are less than <31 weeks
D. Newborns <31 weeks
A. Newborns <31 weeks and <1250gr
- (Repeat question): 10 year old girl diagnosed with optic neuritis 3 months ago. She is currently asymptomatic. How do you counsel her mother:
Chance of recurrence is low
The gamma globulin she received protects against recurrence
Risk of macular degeneration (macular spared)
She is at significant risk of developing MS
She is at significant risk of developing MS
A 3 month old baby presents with a chronic history of mucopurulent discharge from one eye and occasional crusting from the other eye. The conjunctiva are not red. What do you do:
a. Refer to ophthalmology
b. Dacryocystectomy - treatment for dacryocystocele (subcutaneous mass)
c. Nothing
d. Antimicrobial eyedrops
c. Nothing?
mucopurluent
Child with hyphema, when is rebleeding most likely to occur
a. 24 h
b. 4 days
c. 1 week
d. 2 week
4d
