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D&T 2: Exam 2 > Opthopathology > Flashcards

Opthopathology Flashcards

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1
Q

Lamina cribrosa

A

Location at which the sclera is penetrated by the optic nerve; thinner and more prone to rupture at this location

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2
Q

Limbus

A

Important surgical and pathological landmark indicating where the clear sclera to opaque sclera; regular stromal lamellae to irregular lamella

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3
Q

Conjunctival regions

A
  1. Palpebral- lines the inside of the eyelid and tightly attached to the tarsal plate; when inflamed, it forms tiny folds
  2. Superior/Inferior fornices- Composed of pseudostratified columnar epithelial and goblet cells to secrete mucous; also contains lacrimal ductules
  3. Bulbar- Consists of stratified squamous and covers the eye
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4
Q

Bowman’s Membrane

A

Basement membrane underlying the corneal epithelium

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5
Q

Descement Membrane

A

Basement membrane to corneal endothelial cells; thickens w/ age and is the site of Kayser-Fleischer ring deposition

-

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6
Q

Retinal layers

A

Retinal Pigment Epithelium Layer- Absorbs light and reduces scattering to increase visual acuity

Photoreceptor layer- Consists of rods and cones

Bipolar layer- Perform lateral inhibition to increase contrast for vision

Ganglion cell layer- Relay visual input to the occipital lobe

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7
Q

Meibomian Glands

A

Tarsal glands

-Secrete lipid rich substance that keep tears over the cornea

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8
Q

Tear Film

A

Covers the anterior surface of the eye and provides oxygen and nutrients, a smooth optical surface, lysozymes, and Igs

Consists of the superficial oily layer (Meibomian, Zeis, and Moll glands), the middle aqueous layer (lacrimal glands), and the superficial mucous layer (goblet cells)

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9
Q

Acute Angle Closure Glaucoma

A

Obstruction of aqueous outflow from the posterior chamber via closure by the iris leads to congestion of the conjunctival vessels; can maintain w/ acetazolamide but IMMEDIATELY REFER TO OPTHO FOR LASER PERIPHERAL IRIDOTOMY

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10
Q

Iritis

A

Inflammation of the iris assoc. w/ photophobia, pain, possible hypopion (buildup of yellow stuff) and ciliary flushing that stops at the limbus

-Treat w/ topical steroids and possible systemic anti-inflammatories if related to other disease

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11
Q

Herpes Simplex Keratitis

A

Presents as a corneal “dendritic” ulcer that can be treated w/ topical steroids and anti-virals

-Usually caused by HSV-1

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12
Q

Bacterial Keratitis

A

Infection of the cornea usually caused by improper contact hygeine that presents as an opaque ulcer surrounded by a clear cornea

-Tx should start off empiric before cultures come back as this is a sight threatening condition

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13
Q

Bacterial Conjunctivitis

A

Self-limiting infxn usually caused by S. epidermidis; eyelids frequently stuck together when waking up due to large amount of yellow discharge

Tx: Wash away the discharge and treat w/ broad-spectrum antibiotic drops and ointment

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14
Q

Viral Conjunctivitis

A

Highly infective condition that is usually caused by an adenovirus (cold); tx is usually supportive

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15
Q

Neonatal Conjunctivitis

A

Chlamydial infxn that presents 5-19 days postpartum and present w/ mucopurulent discharge and possible assoc. otitis or rhinitis

Tx: Topical tetracycline; oral erythromycin

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16
Q

Neonatal Gonococcal Conjunctivitis

A

Presents 1-3 days postpartum as a highly purulent and aggressive discharge; tx w/ topical and systemic penicillin or possible severe corneal damage

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17
Q

Scleritis

A

Granulomatous inflammation of the sclera that can lead to permanent vision loss; typically assoc. w/ systemic AI disease (often RA)

-Tx w/ ORAL NSAIDs and and steroids

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18
Q

Blepharitis

A

Chronic, bilateral inflammation of the eyelid margin that presents as burning, pain, and crusting of the eyelids, especially in the morning; tx includes ongoing use of warm compresses, chronic tetracyline, and topical steroids and antibiotics for acute flares

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19
Q

Dacrocystitis

A

Infection of the lacrimal sac secondary to lacrimal duct obstruction; presents as a red, swollen lesion in the area of the medial canthus

Tx: Warm compression and oral antibiotics; possible incision and drainage

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20
Q

Hordeolum

A

Small abscess cause by acute staphylococcal infxn of the Meibomian glands; typical presentation is a small, inflamed lesion on the eyelid

Tx: Warm compresses, oral abs, and possible drainage

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21
Q

Chalazion

A

Chronic lipogranulomatous lesion caused by blockage of the tarsal glands that presents as a painful nodule that may compress on the cornea and affect vision

-Pts. w/ acne rosacea at increased risk

Tx: Usually ends up needing surgical drainage

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22
Q

Pterygium

A

Triangular sheet of fibrovascular tissue that grows over the cornea that develops in pts. in hot climates or w/ ocular dryness

-Tx: Surgical incision

Pingueculm is more common and does not cross the limbus into the cornea

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23
Q

Keratoconjunctivits sicca

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A

Dry eye resulting from decreased tear prod. presents as irritation, foreign body sensation, burning, and fluctuations in visual acuity; my be due to atrophy of lacrimal tissue or destruction by monocytes (Sjogren’s)

Tx: Tear substitutes

24
Q

Entropion

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A

Inward turning of the eyelid causing discomfort due to the eyelashes rubbing against the eyeball; tx is usually surgical

25
Ectropion
Condition in which the lower eyelid is turned outward resulting in decreased function of the lid, tears streaming down the face, and a very red eye Tx: Surgical reattachment of the lateral canthus tendon to the lateral orbital wall
26
Alcohol Use Disorder
Presentation: Pt. drinks more than intended and wants to cut down but cant; interferes w/ multiple aspects of the pts. life and has withdrawal sx if pt does not drink; possible Wernicke-Korsakoff PE/Labs: Non-megaloblastic macrocytic anemia; Vit-B12 screen; Pancreatitis, pregnancy, glucose, and psych evals should also be performed Pharm: Disulfarim, Naltrexone, supportive Psych: AA, Friends/Family support, Change social cues
27
Alcohol Withdrawl
Presentation: Sweating, tachycardia, tremors, insomnia, restlessness, anxiety PE/Labs: Vital signs, EKG, check for infxn and pregnancy Pharm: Lorazepam/Diazepam, Carbamazepine, antipsychotics, clonidine Psych: Addiction therapy
28
Adie's Tonic Pupil
Caused by denervation of the post-ganglionic supply to the sphincter pupillae and ciliary muscle; almost always unilateral and thought to be of viral origin **Affected pupil is large and irregular w/ an absent light reflex
29
CN III Palsy
Carries parasympathetic fibers to the eye therefore a palsy... =>>misalignment, mydriasis, ptosis ***If the PUPIL is INVOLVED =>> URGENT (is a compressive issue and could be an aneurysm of the PCA)
30
Disc drusen
Benign deposits on the optic nerve that makes it appear irregular
31
Optic neuritis
Typically seen in MS pts.; will see plaques around the optic nerve on MRI
32
Amaurosis fugax
A transient ischemic attack on the optic nerve that usually resolves on its own -Can cause Brief vision loss and indicate circulatory/vessel disorders
33
Sx suggestive of vitroretinal disorders
1. Flashes- often caused by tugging of the retina by the vitreous and is often the first sign of detachment 2. Floaters- Moving objects often assoc. w/ benign vitreous detachment or possible intraocular bleeding 3. Blurring/Distortion (subretinal fluid), Minimalization, 4. Progressive dimming of vision (hemorrhage, detachment) 5. Abrupt vision loss (detachment)
34
Non-proliferative Diabetic Retinopathy
Changes to the capillaries of the eye including BM thickening, endothelial damage, etc. =>> leakage of fluid, cells, and lipids into the eye which cause the appearance of hemorrhages and lipid deposits on the retina =>> all lead to retinal ischemia
35
Proliferative Diabetic Retinopathy
Proliferation of new blood vessels in response to retinal ischemia leads to progressive loss of vision
36
Central Retinal Vein Occlusion
Occurs due to increased pressure in the central retinal artery =>> diffuse hemorrhage and vision loss -branch retinal vein occlusion can occur thru same concept
37
Retinoblastoma
Presents as a white reflex (leukocoria) in a child - Is the most common intraocular malignancy of child and can destroy the eye and metastatically spread if untreated - May be familial (inheritance of deletion of 13q14.2 Rb gene; more common) or sporadic (requires two mutations)
38
Strabismic Amblyopia
Mononuclear suppression of a deviating eye in children that can result in potentially permanent loss of vision in that eye -Can also be due to refraction errors or occlusions
39
Strabismus
Can be concomitant (size of deviation does not vary w/ direction of gaze) or incomitant -Esotropia= eyes pointing in Hypertropia= eyes pointing upward
40
Retinopathy of prematurity
Occurs to remnant of hyaloid artery that originates from the optic nerve and usually disintegrates by Week 34 of gestation; is a problem in pre-term infants *Typically affects infants born at
41
Lagopthalmos
Pt. cannot close their eye completely
42
Septal Cellulitis
Can be pre-septal and limited to the anterior portion of the orbital septum OR posterior to the septum and present as a much more infiltrating infection
43
Herpes Zoster Opthalmicus
Can present similar to HSV-1 infxn however, there will be a Hutchinson's sign on the skin alongside typical dermatomal vesicle breakout typical to VZV
44
Orbital Tumors
1. Rhabodmyosarcoma 2. Capillary Hemangioma 3. Optic nerve glioma (nerve itself is enlarged) 4. Optic nerve meningioma (nerve itself is unaffected but surrounded by tumor) 5. Lacrimal gland tumor 6. Metastatic carcinoma (eyes appear to have "bilateral shiners")
45
Shaken baby syndrome retinal hemorrhage
Only disease that causes sub-,intra-, and pre-retinal hemorrhages
46
Sickle Cell Anemia Retinal Findings
Anterior segment- Traumatic hyphema Posterior Segment- Multiple presentations a. Salmon Patch (superficial hemorrhage) b. Sunpatch- Pigmented Chorioretinal scars around retinal damage c. Sea fan- Capillary proliferation due to retinal ischemia
47
Uveal Malignant Melanoma
Proliferation of melanocytes in the choroid; most common primary malignant intraocular tumor -Appears as a bluish-gray patch
48
Sarcoidosis effects on the eye
Formation of nodules on the eyes and on the palpebral conjunctiva -Also causes a granulomatous uveitis
49
Behcet's Disease
Classic triad of: 1. Acute iritis w/ hypopion 2. Aphthous stomatis (mouth ulcers) 3. Genital ulcers
50
Possible Ocular issues w/ Aids
Adnexal disease (bacterial infxn; Kaposi's sarcoma on the conjunctiva that can be moved around) CMV Retinitis (ketchup on a pizza)
51
Syphilis effects on the eye
Causes interstitial keratitis in the anterior segment as blood vessels invade the cornea producing a "salmon patch" giving clouded vision - Eventually, they become ghost vessels, however, they can rupture if reperfused - Will also cause uveitis, retinitis, papillitis
52
Hyaloids
Posterior part of the vitreous humor that can detach in old age
53
Embryological derivation of the retina
The diencephalon
54
Open angle glaucoma
Presents with ocular pain, redness, nausea, corneal edema, FIXED AN DILATED PUPIL, narrow anterior angle chamber Tx:
55
To produce cycloplegia, what kind of drug is used?
Parasympathetic antagonist such as atropine, Homatropine, Cyclopentolate

D&T 2: Exam 2 (5 decks)

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