Structural Eye Disorders and Glaucoma B&B

Question 1

how does scleritis present?

Answer 1

dark red eyes, severe boring pain with eye movement (extra-ocular muscles insert on sclera) - potentially blinding

half of cases associated with systemic disease, esp. rheumatoid arthritis!

Question 2

scleritis and episcleritis are both commonly associated with what systemic disease?

Answer 2

rheumatoid arthritis - disease of connective tissues, sclera is connective tissue of the eye!

Question 3

how does episcleritis present?

Answer 3

[episcleritis is thin layer above sclera]

tear, localized redness, mild/no pain, self-limited

acute inflammation, usually idiopathic but often associated with rheumatoid arthritis

Question 4

which patients are particularly at risk for keratitis?

Answer 4

corneal inflammation with bacterial/viral/fungal cause

contact lens wearers at risk! sight-threatening disorder if cornea becomes damaged

presents with pain, photophobia, red eye, foreign body sensation

Question 5

corneal abrasions are common among contact lens wearers and can become infected with ______, and thus are treated with _______

Answer 5

pseudomonas - treat with ciprofloxacin (fluoroquinolone) eye drops

Question 6

how does ocular disease caused by HSV-1 present?

Answer 6

HSV-1 causes herpes labialis (cold sores) and keratoconjunctivitis: infection of cornea and conjunctiva with pain/redness/discharge

most ocular disease is caused by recurrent HSV (reactivating after establishment of viral latency)

Question 7

what are the most common viral (3) and bacterial (6) causes of conjunctivitis?

Answer 7

viral causes (80%): adenovirus (majority!), measles, HSV-1

bacterial: S. aureus, H. influenza, S. pneumoniae, Moraxella catarrhalis, Neisseria gonorrhea, Chlamydia,

Question 8

how does the most common cause of conjunctivitis present?

Answer 8

80% of conjunctivitis is viral, and 60-90% of those are caused by adenovirus (naked, DNA, very stable on surfaces)

causes a watery discharge (not purulent like bacterial conjunctivitis!)

adenovirus also causes pharyngitis and pneumonia

Question 9

what is the classic triad of measles infection (rubeola)?

Answer 9

enveloped, (-)RNA paramyxovirus

causes Cough, Coryza, Conjunctivitis + Koplik spots (mouth) and maculopapular rash

Question 10

what are the typical causes of bacterial conjunctivitis in adults vs children? (3 each) what about in neonates (2)?

Answer 10

adults:
1. staph. aureus
2. strep. pneumoniae
3. H. influenzae

children:
1. H. influenzae
2. strep. pneumoniae
3. Moraxella catarrhalis

neonatal: Neisseria gonorrhea or chlamydia

Question 11

what is given as prophylaxis for neonatal conjunctivitis?

Answer 11

aka ophthalmia neonatorum, caused by Neisseria gonorrhea or Chlamydia infection from passage through birth canal

untreated —> visual impairment

prophylaxis: erythromycin ophthalmic ointment

Question 12

Reiter’s syndrome

Answer 12

triad of symptoms presenting with reactive arthritis (autoimmune arthritis following infection by intestinal bacteria or chlamydia trachomatis)

1. arthritis (duh)
2. conjunctivitis (red eye, discharge)
3. urethritis (dysuria, frequency)

Question 13

what 3 structures are considered part of the uvea?

Answer 13

1. iris
2. ciliary body
3. choroid (vascular layer)

Question 14

anterior uveitis =
intermediate uveitis =
posterior uveitis =

Answer 14

recall uvea = iris + ciliary body + choroid

anterior uveitis = iritis/iridocyclitis (pain, redness)

intermediate uveitis = vitreous humor inflammation

posterior uveitis = chorioretinal inflammation (floaters, decreased vision, no pain)

Question 15

what are the possible etiologies of uveitis?

Answer 15

1. infectious - agents that infect CNS (HSV, CMV, toxoplasmosis, syphilis)
2. associated with systemic inflammatory disease (choroid = vascular layer of eyeball)

recall uvea = iris + ciliary body + choroid

Question 16

hypopyon

Answer 16

inflammatory infiltrate in anterior chamber of eye

seen in endophthalmitis (inflammation of aqueous/vitreous humor), keratitis, uveitis

Question 17

describe the life cycle of aqueous humor

Answer 17

1. produced by ciliary muscle epithelium (stimulated by beta2 receptors)
2. drained out of anterior chamber by trabecular network
3. drained out of eye via Canal of Schlemm

Question 18

how do the parasympathetic and sympathetic nervous systems regulate intraocular pressure, respectively?

Answer 18

PSN (via muscarinic receptors): constricts ciliary muscle allow aqueous humor to drain and lower intraocular pressure

SNS (via beta2 receptors): stimulates ciliary muscle epithelium to produce aqueous humor and increase intraocular pressure

Question 19

what is the pattern of vision loss with glaucoma?

Answer 19

peripheral vision lost first, then central

Question 20

open angle vs closed angle glaucoma (cause and presentation)

Answer 20

open angle (more common): overproduction or decreased drainage of aqueous humor —> chronic, no symptoms until loss of eyesight begins (peripheral first)

closed angle: angle for drainage suddenly closes —> abrupt onset of painful/red eye, blurred vision with halos, “rock hard” eye, ophthalmologic emergency!

Question 21

what factors/drugs can trigger closed angle glaucoma?

Answer 21

closed angle: angle for drainage suddenly closes —> abrupt onset of painful/red eye, blurred vision with halos, “rock hard” eye, ophthalmologic emergency!

symptoms triggered when pupil dilates - such as entering a dark room or drugs with dilating effects (scopolamine, atropine)

Question 22

how does glaucoma appear in fundoscopy?

Answer 22

“disc cupping” - optic disc appears large and bright like the sun

Question 23

how are the following drugs used for chronic management of open glaucoma?
a. M3 agonists
b. alpha2 agonists
c. beta blockers
d. prostaglandin analogues
e. carbonic anhydride inhibitors

Answer 23

a. M3 agonists: contracts ciliary muscle (more drainage)

b. alpha2 agonists AND c. beta blockers: blocks ciliary epithelium from releasing aqueous humor

d. prostaglandin analogues: vasodilate Canals of Schlemm

e. carbonic anhydride inhibitors (oral acetazolamide): decrease aqueous humor synthesis

Question 24

how do carbachol and pilocarpine treat open angle glaucoma?

Answer 24

parasympathomimetics (muscarinic agonists)

cause contraction of ciliary muscle —> opens trabecular meshwork for more aqueous humor drainage

Question 25

how do apraclonidine and brimonidine treat open angle glaucoma?

Answer 25

alpha2 agonists —> decrease aqueous release from ciliary body epithelium

note can have ocular side effects - blurred vision, ocular hyperemia, foreign body sensation, itchy eyes

Question 26

how are bimatoprost/latanoprost/tafluprost/travoprost used in the management of open angle glaucoma?

Answer 26

all PROSTaglandin analogues (“-prost”)

vasodilate Canals of Schlemm —> more drainage/outflow

note, will darken iris

Question 27

how does latanoprost treat glaucoma?

Answer 27

Prostaglandin analog (prodrug for PGF2a) - increases uveoscleral outflow in treatment of glaucoma

latanoPROST[aglandin]

Question 28

how does brinzolamide treat glaucoma?

Answer 28

Carbonic anhydrase inhibitor - decreases aqueous humor production

Question 29

how does apraclonidine treat glaucoma?

Answer 29

Alpha-2 agonists - Decreases aqueous humor production, increase uveoscleral outflow

Question 30

for what eye disorder is bevacizumab used?

Answer 30

Age-related macular degeneration - blocks neovascularization mediated by VEGF

Question 31

what is the biggest modifiable risk factor for both wet and dry age-related macular degeneration (ARMD)?

Answer 31

smoking

Question 32

wet vs dry age-related macular degeneration (ARMD)

Answer 32

wet/exudative/neovascular: minority, severe vision loss, choroidal neovascularization may cause subretinal hemorrhage, treated with anti-VEGF

dry/nonexudative: majority (80%), slowly progression pigment changes, peripheral vision lost first, geographic atrophy at end stage (dense scotoma/blind spots in areas of atrophy)

Question 33

papilledema vs papillitis

Answer 33

papilledema = bilateral optic disc edema due to elevated intracranial pressure
(intracranial mass, pseudotumor cerebri, cerebral venous thrombosis, Chiari, aqueductal stenosis)

papillitis = unilateral or bilateral, due to optic nerve inflammation
(optic neuritis, HTN, diabetic, ischemic)