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Neurological System > 1-Opthalmology > Flashcards

1-Opthalmology Flashcards

1
Q

Review Eye Anatomy Lecture/Pictures

A

Review Now

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2
Q

Describe ectropion

A

Eye lid begins to turn out exposing the conjunctiva.

Caused by old age, congenital, paralytic

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3
Q

Describe blepharitis

A

Inflammation of eyelids.
Caused by staph aureus or plugging the lacrimal glands.

Treat with Lid scrubs, baby shampoo, and warm compresses

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4
Q

Describe chalazion

A

non-infectious lipogranuloma of the meibomian gland.

NOT PAINFUL OR INFECTIOUS

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5
Q

Describe treatment for a chalazion?

A

excision using a chalazion clamp, can recur

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6
Q

Describe Hordeolum

A

acutely red, PAINFUL nodule at eye lid margin.

Looks like a chalazion but is PAINFUL and INFECTIOUS

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7
Q

Describe treatment for a Hordeolum.

A

Antibiotic ointment and dry heat (infection) don’t give moisture.

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8
Q

What is a Xanthelasma?

A

Cholesterol deposits seen in familial hypercholesterolemia

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9
Q

What is Dacryocystitis?

A

Inflammation of the lacrimal sac, caused by obstruction of the nasolacrimal duct causing infection

Treated with pus drainage (incision), local and systemic antibiotics.

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10
Q

What is a definitive treatment for Dacryocystitis?

A

Surgical implementation of a fistula between lacrimal sac and nasal cavity. Basically shunting.

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11
Q

Describe Dacryoadenitis.

A

Inflammation of the Lacrimal gland, upper eye lid will be red and swollen

Caused by pneumococci, staph, and occassionally strep.

Treat with moist/dry heat and antibiotics.

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12
Q

Describe conjunctivitis.

A

Inflammation of the eye surface. Denoted by vascular dilation, cellular infiltration, and exudation.

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13
Q

Whats the difference between Infectious and Non-Infectious conjunctivitis?

A

Infectious: Bacterial, viral, parasitic, mycotic.

Non-Infectious: Persistant irritation, Allergies, Toxic, Secondary (stevens-johnson syndrome?)

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14
Q

Viral conjunctivitis has what type of discharge?

A

Serous

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15
Q

Chlamydial conjunctivitis has what type of discharge?

A

Mucoid/Mucopurulent

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16
Q

Bacterial conjunctivitis has what type of discharge?

A

Purulent

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17
Q

Allergic conjunctivitis has what type of discharge?

A

Serous, Mucoid

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18
Q

Toxic conjunctivitis has what type of discharge?

A

Serous, Mucoid, Mucopurulent

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19
Q

Major Bacterial causes of conjunctivitis in children?

A

Strep Pneumo
Hamophilus influenzae
Staph spp.
Moraxella spp.

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20
Q

Major bacterial causes of conjunctivitis in adults?

A

Staph spp.
Strep spp.
Gram negative organisms: E.Coli, Pseudomonas, Moraxella.

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21
Q

Discuss treatment options for bacterial conjunctivitis.

A

Erythromycin
Bacitracin-polymyxin B ointment (polysporin)
Gentamicin, Tobramycin
Flouroquinones

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22
Q

Virus responsible for epidemic keratoconjunctivitis?

A

Adenovirus - acute red eye, watery, itching, mucoid discharge,

VERY contagious

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23
Q

Describe Herpes Keratitis.

A

Can be seen easily with flourescene. A dendritic ulcer is the form it takes.

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24
Q

What medication should never be given with suspected viral conjunctivitis?

A

Steroids! It can cause serious issues if pt. has Herpes keratitis

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25
Q

REVIEW PATHWAY OF LIGHT THROUGH RETINA AND LAYERS

A

REVIEW

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26
Q

What is optic nerve formed by?

A

Axons of the retinal ganglion cells.

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27
Q

Where does the optic nerve exit the orbit?

A

Optic Canal

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28
Q

Where does the optic tract project to?

A

They synapse in the Lateral Geniculate Body

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29
Q

Which loop carries superior radiations (inferior fields)?

A

Baums loop in the parietal lobe.

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30
Q

What loop carries inferior radiations (superior visual field)?

A

Meyer’s loop in the temporal lobe

31
Q

Where do meyers and baums loops synapse in the cortex?

A

Visual Cortex of occipital lobe

32
Q

Lesions before and after the chiasm are?

A

Before: Unilateral
After: Bilateral

33
Q

Chiasmal lesions cause what types of loss/

A

Bitemporal Hemianopsia (injure the crossing temporal visual field informaiton)

34
Q

Lesions to the optic tract prior to the LG body?

A

CL Homonymous Hemianopsia

35
Q

Lesions of the superior retinal fibers (baums loop)?

A

Inferior homonymous quadrantanopsia

36
Q

Lesions of the inferior retinal fibers (meyer’s loop)?

A

Superior homonymous quadrantanopsia

37
Q

What type of lesion will be seen if there is a lesion of the occipital lobe resulting from a PCA stroke?

A

Homonymous hemianopsia with macular sparing.

38
Q

REVIEW PICS OF RETINA

A

REVIEW

39
Q

You are viewing a retina and the vessels are showing spontaneous pulsations. Is this ok?

A

Yes, spontaneous pulsations are a normal finding.

With elevated ICP, the pulsations will disappear.

40
Q

What are lisch nodules?

A

Copper colored spots all over the iris. Seen in neurofibromatosis type 1

41
Q

Cafe au lait spots?

A

Pigmented lesions found in patients with NF-1

42
Q

Briefly discuss thyroid eye disease?

A

Inflammation of extraocular muscles. Generally associated with graves disease.

Can compress CNII or cause diplopia

43
Q

What is a orbital pseudotumor?

A

Idiopathic inflammation of the extraocular muscles

Treated with steroids

44
Q

Briefly discuss the pupillary pathways?

A

Optic nerve - afferent limb

Parasympathetic - miosis

Sympathetic - mydriasis

45
Q

How do the Parasympathetics get to the eye and cause constriction?

A

Travel with CNIII but bypass the ciliary ganglion, travel through short ciliary nerve to iris sphincter muscle to cause constriction

46
Q

What doese the swinging flashlight test assess?

A

Afferent pupillary defects
aka Marcus-Gunn pupil
- eyes show direct and consensual light reflexes during normal testing, but during the swinging light test the affected eye causes significant dilation of both eyes.

47
Q

Describe common causes for 1st, 2nd, and 3rd order sympathetic lesions causing eye deficits.

A

1st order: hypothalamus and brainstem lesions (Lateral Medullary syndrome)

2nd order: Thoracic outlet, pulmonary apex lesion (Pancoast tumor)

3rd order: INTERNAL CAROTID DISSECTION, prestents painful Horner, must Rule Out!!

48
Q

Describe the Cocaine Test for Horner syndrome.

A

Cocaine Test - norepinephrine reuptake inhibitor drops cause a dilation in the unaffected eye due to norepinephrine being present, in the affected eye - there is no norepinephrine to begin with so there is little to no effect.

Positive horners is no affect via cocaine drops in the affected eye

49
Q

Describe the apraclonidine test for Horner syndrome.

A

Alpha 1 agonist which would reverse the effects of a Horner’s eye. So there will be exceptional dilation in the affected eye.

50
Q

Describe the Hydroxyamphetamine test for a Horner syndrome.

A

Helps localize the lesion. All it does is mimick a stimulus for the release of norepinephrine

1st and 2nd order lesions will be fixed because all that is missing is the stimulus and show dilation

3rd order lesion will have no effect. Because there is no norepinephrine to release.

51
Q

Describe anisocoria.

A

Unequal pupils

Important to measure pupils in the light and dark.

52
Q

DDx for anisocoria that stays the same through dark and light?

A

Physiologic

53
Q

DDx for anisocoria that is worse in the dark?

A

Horners
Structural
Pharmacologic

54
Q

DDx for anisocoria that is worse in bright light?

A

Adies tonic pupil
CN3 Palsy
Pharmacologic
Structural

55
Q

An aneurysm to which artery is a major cause of compressive CNIII palsy

A

PCOM as it comes off of the ICA

56
Q

Describe Adie’s tonic pupil

A

Dialated pupil, poor light constriction, but constricts with accomodation (light-near dissociation)

57
Q

Describe testing for Adie tonic pupil.

A

Pilocarpine - mimics PNS to M3 muscarinic receptors in iris sphincter muscle
Adie’s pupil will constrict due to denervation hypersensitivity and the normal eye will not.

58
Q

Describe Argyll Robertson pupil.

A

“prostitutes pupil”
Associated with neurosyphilis.

Bilateral Small pupils with light-near dissociation.

Accomodates but doesn’t react.

59
Q

What is the difference between diplopia with both eyes open vs one closed?

A

True Binocular: Each eye is seeing a slightly different image

Monocular: Usually refractive, astigmatism, macular degeneration

60
Q

What is a common autoimmune cause of diplopia?

A

Thyroid Eye Disease (Graves disease)
- Fibrosis and enlargement of EO muscles esp. IR and MR.

Causes vision loss and diplopia

61
Q

Patient presents with changing pattern of diplopia and ptosis. Fluctuation and fatigability at the end of the day.

A 
Myasthenia Gravis (NMJ disorder)
- Endrophonium test w/ AchE Inhibitor to see if symptoms improve.
62
Q

How would you treat a myasthenia gravis/

A

AchE inhibitors - Neostigmine, Physostigmine

Immunosuppresants - prednisone

63
Q

Describe Internuclear Opthalmoplegia.

A

Defect in MLF causing conjugate gaze palsy.

Convergence is still in tact because it is a different pathway.

64
Q

What kinds of problems present with an MLF lesion/ symptoms?

A

MS patients (demyelination diseases)

Older Patiens - CVD, Tumor

65
Q

What is one and a half syndrome?

A

One side can’t ad or abduct

Other side can not adduct

66
Q

What is the presentation of a CNVI nuclear lesion?

A

Both eyes have trouble moving toward the side of the lesion.

Lesion side lateral rectus will show atrophy.

67
Q

What is proptosis?

A

Exopthalmose usually caused by a tumor behind the eye

68
Q

What should be done if a corneal abbrasion is suspected?

A

Look at the eye with flourescein stain to get a better look at any lesions present.

69
Q

What should be given to patients with corneal abrasions?

A

Flouroquinolones for contact wearers

Erythromycin drops for others

Give topical anesthetics only in office during exam. NONE to take home.

70
Q

How does iritis present?

A

photophobia, painful inflammation/injections in anterior portion of sclera

71
Q

How is iritis treated?

A

Atropine, and perhaps steroid drops for severe cases

72
Q

Describe the 2 mechanisms of Hyphema/

A

Traumatic: ruptured iris blood vessel

Spontaneous: Sickle cell usually

73
Q

What are the treatments for hyphema?

A

Timolol for IOP

Mannitol

Neurological System (10 decks)

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