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2 Flashcards

1
Q

features of Disciform keratitis (HSV)

A
  1. Disc-shaped stromal edema
  2. intact epithelium
  3. Mild iritis with localized granulomatous KP (mutton fat)
  4. ↑IOP
  5. No necrosis or corneal neovascularization
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2
Q

features of Necrotizing interstitial keratitis (HSV)

A
  1. multiple or diffuse, whitish corneal stromal infiltrates
  2. +- epithelial defect
  3. Stromal inflammation, thinning, neovascularization. → cornea may perforate
  4. Iritis, hypopyon, glaucoma
  5. Bacterial and fungal superinfection
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3
Q

how to treat HSV Corneal Epithelial Disease?

A
  1. Antiviral (e.g. Ganciclovir 0.15% ophthalmic gel, trifluridine 1% drops, vidarabine 3% ointment)
  2. cycloplegic
  3. taper topical CS
  4. debridement
  5. aft 1-2 wks unresolved→ consider superinfection
    - discontinue topical antiviral
    - nonpreserved artificial tear ointment
    - Abx ointment
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4
Q

how to treat HSV corneal stromal disease?

A

Depending on severity, vision and types.

  1. Cycloplegic
  2. Topical Antiviral prophylaxis (prevents HSV keratouveitis)
  3. Topical CS (e.g. prednisolone acetate 1% / loteprednol 0.5%)
  4. Topical Abx (epithelial defect)
  5. Aqueous suppressants (↑IOP) avoid PG
  6. Tissue adhesive/corneal transplantation (corneal perforation)
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5
Q

what should be noted when treating HSV corneal stromal disease w/ Topical CS ?

A

Diagnose and treat any associated overlying epithelial defect and bacterial superinfection w/ Abx drops/ointment.
[Topical steroids are contraindicated in those with infectious epithelial disease.]

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6
Q

local SE of topical antivirals and Rx

A

toxic / allergic reaction: papillary / follicular conjunctivitis (typically aft 3 wks)
Rx: switch to oral antivirals

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7
Q

what additional work-up should be conducted in VZV eye disease compared to HSV?

A
  1. dilated fundus: acute retinal necrosis

2. Systemic: Immunodeficiency

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8
Q

systemic steroids use in Immunocompromised patients

A

Immunocompromised patients should not receive systemic steroids

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9
Q

topical antivirals or systemic oral antivirals for patients w/ VZV ocular findings

A

systemic oral antivirals 7-10 ds(e.g. acyclovir, famciclovir, valacyclovir)

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10
Q

duration of acute conjunctivitis

A

< 4 wks

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11
Q

“vital signs” of ophthalmology

A

Vision, pupil, and pressure [bf dilating]

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12
Q

which tissue has the highest protein concentration in the body?

A

The lens (65% water, 35% protein)

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13
Q

The thinnest bone in the orbit

A

lamina papyracea

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14
Q

bone that breaks most often during blunt trauma to the orbit

A

maxillary bone

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15
Q

Where does the retina get its nutrition supply?

A
  • inner 2/3rds: retinal vessels.

- outer 1/3: choroid plexus.

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16
Q

Which full-thickness eyelid laceration is more dangerous – medial or lateral lacerations?

A

medial (canalicular tear-drainage system)

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17
Q

Which extraocular muscle doesn’t originate at the orbital apex?

A

inferior oblique (orbital floor)

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18
Q

ddx of itchy eyes

A
  • Conjunctivitis (esp. allergic, vernal, and viral), giant papillary conjunctivitis
  • blepharitis,
  • dry eye syndrome,
  • contact lens-related problems
  • topical drug allergy or contact dermatitis
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19
Q

difference btw hordeolum(stye) and chalazion

A
  • chalazion: blocked inflamed swollen Meibomian glands, nontender
  • stye: ifxn of a sebaceous gland or eyelash follicle, superficial to the tarsal plate, painful
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20
Q

DDx of tearing

A
  • lids, lashes,
  • lacrimal
  • cornea
  • conjuctiva
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21
Q

follicles vs. papillae

A
  • Follicles: viral, chlamydial, toxic
  • dome-shaped, avascular/white nodules, filled w/ lymphocytes
  • Papillae: allergic, bacterial
  • flat-topped, red dots(central vessel) of varying sizes
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22
Q

signs of viral conjunctivitis

A
  • Inf palpebral conjunctival follicles

- tender palpable preauricular LN

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23
Q

membranous vs. pseudomembranous conjunctivitis

A
  • membranous: removal difficult w/ bleeding

- psedomembranous: removal easy w/o bleeding

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24
Q

corneal findings in viral conjunctivitis/epidemic keratoconjunctivitis

A
  • punctate keratopathy
  • Fine intraepithelial microcysts
  • Subepithelial infiltrates (SEIs) (a few wks aft onset)
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25
Q

most common cause of viral conjunctivitis

A

Adenovirus

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26
Q

variants of viral conjunctivitis

A
  1. Epidemic keratoconjunctivitis
  2. Pharyngoconjunctival fever
  3. Acute hemorrhagic conjunctivitis (last 1-2wks)
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27
Q

course of viral conjunctivitis

A
  • self-limited
  • first 4 to 7 ds: gets worse
  • 2 to 3 weeks:resolve (potentially longer with corneal involvement).
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28
Q

Rx of viral conjunctivitis/epidemic keratoconjunctivitis

A
  • avoid contact, handwashing
  • tears
  • cool compress
  • antihistamin(e.g. epinastine0.05%)
  • peel
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29
Q

topical drops for allergic conjunctivitis

A

severity
-tears
-antihistamine/mast cell stablizer
[Mild topical steroid (e.g., loteprednol / fluorometholone) for severe]
[+ Oral antihistamine (e.g., diphenhydramine / loratadine) in moderate-to-severe]

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30
Q

signs of vernal/atopic conjunctivitis

A
  • sup. and limbal papillae
  • Horner-Trantas dots (limbal raised white dots of degenerated eos)
  • sup. corneal shield ulcer
  • SPK
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31
Q

why should patients on topical steroids should be monitored regularly?

A

IOP

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32
Q

how to treat shield ulcer?

A
  • topical steroids (e.g.loteprednol, prednisolone acetate, dexamethasone)
  • topical Abx
  • cycloplegic
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33
Q

what feature is prominent in bacterial conjunctivitis?

A

Purulent white-yellow discharge

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34
Q

two types chlamydial conjunctivitis

A
  1. chlamydial inclusion conjunctivitis (STD)

2. trachoma (poor hygiene, endemic area)

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35
Q

Tetracycline derivatives are contraindicated in

A
  • children <8 yr,
  • pregnant,
  • nursing mothers.
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36
Q

Arlt line

A

linear or stellate scarring of superior tarsal conjunctiva

seen in trachoma

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37
Q

Herbert’s pits

A

depressions in superior limbus due to involution and necrosis of follicles
(seen in trachoma)

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38
Q

Corneal findings in trachoma

A
  • epithelial keratitis,
  • focal multifocal peripheral and central stromal infiltrates,
  • superficial fibrovascular pannus (most sup.1/3)
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39
Q

WHO classifications of trachoma

A
  • TF (follicular): >5 follicles on the upper tarsus.
  • TI (intense): Inflammation with thickening obscuring >50% of the tarsal vessels.
  • TS (scarring): Cicatrization of tarsal conjunctiva with fibrous white bands.
  • TT (trichiasis): Trichiasis of >=1 eyelash.
  • CO (corneal opacity): Corneal opacity involving at least part of the pupillary margin.
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40
Q

Late complications of trachoma

A
  • Severe dry eyes,
  • trichiasis,
  • entropion,
  • keratitis, corneal scarring, superficial fibrovascular pannus, Herbert pits (scarred limbal follicles), corneal bacterial superinfection, and ulceration.
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41
Q

DDx of Chronic follicular conjunctivitis

A
  • Chlamydia
  • Viral (adenovirus)
  • Bacterial (Moraxella, Staphylococcus aureus)
  • Molluscum contagiosum
  • Microsporidial keratoconjunctivitis
  • Toxic conjunctivitis/medicamentosa
42
Q

DDx of chronic conjunctivitis

A
  • Chronic follicular conjunctivitis
  • Parinaud oculoglandular conjunctivitis (Figure 3)
  • Silent dacryocystitis
  • Contact lens–related problems
  • Conjunctival tumors
  • Autoimmune disease
43
Q

what may cause sub-conjunctival hemorrhage?

A
  • Valsalva
  • Traumatic (isolated/ w/retrobulbar hemorrhage or ruptured globe)
  • HTN, DM
  • Bleeding disorder.
  • Antiplatelet or anticoagulant meds
  • Topical steroid therapy
  • Hemorrhage due to orbital mass (rare)
  • Idiopathic.
44
Q

sub-conjunctival hemorrhage usually clears w/n

A

2-3 wks

45
Q

most prominent sx of scleritis

A
  • severe and boring eye pain
  • radiate to forehead, brows, jaw, sinuses
  • awaken at night
  • worse w/ eye movement and touch
46
Q

characteristics of episcleral vessels

A
  • large, radial
  • movable
  • blanch w/ topical phenylephrine 2.5%
47
Q

Episcleritis vs. Conjunctivitis

A

Conjunctivitis: Diffuse redness and discharge with follicles or papillae.

48
Q

most common cause of episcleritis?

A

unknown 60%

49
Q

Characteristic violaceous scleral hue seen in natural light is seen in _______

A

scleritis

50
Q

scleritis vs. episcleritis

A

Episcleritis: Sclera not involved.

  • blanch with topical phenylephrine.
  • more acute
  • younger
  • mild symptoms, if any.
51
Q

causes for scleritis

A

up to 50%: systemic disease, typically CTD or vasculitic

52
Q

the ISNT rule of neuroretinal rim (NRR)

A

thickness: I>S>N>T

I & S focal notching seen in glaucoma

53
Q

The pressure measurements on the Goldman were calibrated using an average corneal thickness of

A

about 540nm

54
Q

what is Tenon’s capsule?

A

Tenon’s capsule is the deep fascia of the eyes. It is a fibrous layer surrounding the globe of the eye from the ciliary margin of the cornea backwards to the entrance of the optic nerve.
Ant 1/3 back of conjunctiva
Mid 1/3 muscle sheaths
Post 1/3 orbital fat, optic nerve sheath

55
Q

what sign is diagnositic of canaliculitis?

A

Expression of mucopurulent discharge or concretions from the punctum.

56
Q

ddx of canaliculitis

A
  • Dacryocystitis
  • Chalazion
  • Nasolacrimal duct obstruction
57
Q

how to treat canaliculitis?

A
  • remove(canaliculotomy)
  • irrigate(abx)
  • Abx drops and Abx p.o. /nystatin/trifluridine
  • warm compresses
58
Q

is topical Abx enough for Dacryocystitis?

A

No. systemic is also needed.

59
Q

After 10 years, how many diabetics will show signs of retinopathy, and how about after 15 years ?

A

> 50%;nearly 90%

60
Q

what can be seen on the retina of patients w/ Nonproliferative diabetic retinopathy (NPDR)?

A
  • microaneurysms,
  • dot-and-blot hemorrhages,
  • Cotton-wool spots
  • venous beading
  • other vascular anomalies.
61
Q

how to tell if it bleeds w/n the superficial RNFL or deep in the retina?

A

dot-and-blot : deep

flame: superficial

62
Q

what outcomes can occur in PDR?

A

1.Neovascularization→ into the vitreous fluid→
vitreous movement or contraction→ retinal detachment
→sudden hemorrhaging with subsequent vision loss→vessels regress and scar down→massive traction on the retina
2. NVI → sudden neovascular glaucoma

63
Q

the most common cause of blindness in diabetic patients

A

macular edema

64
Q

retinal detachment definition

A

an abnormal separation between the sensory retina and the underlying RPE and choroid plexus

65
Q

which population is prone to have retinal detachment?

A
  1. Myopic. (thinner retina)
  2. eye surgery(cataract extraction)
  3. traumatic sports
66
Q

types of retina detachment

A
  1. rhegmatogenous (most common)
  2. traction (vitreous or DR neovascular)
  3. exudative（breakdown of the blood-retina barrier）
67
Q

floaters in elderly people over 65

A

suspect PVD (posterior vitreous detachment)

68
Q

most worried outcome of PVD

A

Retina detachment

69
Q

sx of retina detachment

A
  1. Flashing lights/photopsias
  2. Floaters
  3. dark curtain
70
Q

flashing lights+floaters

A

retinal detachment until proven otherwise.

71
Q

Shafer’s sign

A

Suspended pigment particles may be seen floating in the anterior vitreous(“tobacco dust” )
It is pathognomonic for a retinal tear.

72
Q

which needs surgery sooner, macula-on or macula-off retina detachment?

A

macula on (to make sure it STAYS on)

73
Q

surgery for retina detachment

A
  1. laser or cryoprobe (tear/hole)
  2. Scleral buckling: a silicone band ‘indents’ for anterior breaks at the equator
  3. pneumatic retinopexy (injects bubble of gas or silicon oil)
  4. vitrectomy(severe and complicated)
74
Q

drusen

A

yellow extracellular breakdown deposits that form deep in Bruch’s membrane.

75
Q

Rx for dry ARMD

A

monitor and antioxidant vitamin

76
Q

metamorphopsia

A

distorted lines that might indicate macular edema (amsler grid)

77
Q

techniques to treat wet ARMD

A
  1. PDT (photodynamic therapy): coagulate the blood vessels without destroying the retina around it
  2. Lucentis(Ranibizumab, anti-VEGF)/Avastin(Bevacizumab)
78
Q

Risk Factors of ARMD?

A
  1. FHx
  2. smoking
  3. obesity
  4. HTN
  5. hypercholesterolemia
79
Q

How do we treat PDR?

A

PRP (pan retinal photocoagulation):ablating the peripheral ischemic retina with a laser→ VEGF↓

80
Q

mechanisms in diabetic retinopathy that might lead to ↓vision

A
  1. Macular edema
  2. Vitreous hemorrhage
  3. Retinal detachment
81
Q

What is a PVD?

A

posterior vitreous detachment – with aging the vitreous jelly liquefies and contracts. A sudden contraction can cause new floaters.

82
Q

Weis ring

A

a piece of optic disk debris that has pulled off with the posterior vitreous detachment(PVD).

83
Q

Wet ARMD

A

choroidal neovascularization that has grown up through Bruch’s membrane.

84
Q

features of visual distortion in Migraine

A
  1. Multicolored photopsias in a zig-zag pattern that obstructs vision,
  2. lasts approximately 20 minutes.
  3. A headache may or may not follow.
  4. Normal fundus examination.
85
Q

does Chronic retinal breaks (Usually asx) need treatment?

A

A retinal break surrounded by pigment suggests chronicity and usually does not require treatment.

86
Q

most common cause of cotton wool spot

A

DM

87
Q

Hollenhorst plaque

A

Cholesterol emboli that are typically refractile, orange, and seen at retinal vessel bifurcations.

88
Q

The normal ratio of diameter of a retinal vein to a retinal artery at a given distance from the center of the optic disc

A

3:2

89
Q

Approximately 70% of arteriovenous crossings are normally of the type

A

artery in front of vein

90
Q

retinal signs of chronic hypertensive retinopathy

A
  1. AV nicking
  2. copper/silver wiring
  3. CWSs
  4. flame-shaped hemorrhages
  5. arterial macroaneurysms
  6. central or branch occlusion of an artery or vein
  7. rarely NV
91
Q

retinal signs of acute/malignant hypertensive retinopathy

A
  1. ‘macular star’ hard exudate
  2. retinal edema
  3. CWSs
  4. flame-shaped hemorrhages
  5. optic nerve head edema
  6. rarely serous RD/VH
  7. Elschnig spots
92
Q

Elschnig spots

A

small, black spots surrounded by light yellow

haloes which represent focal choroidal infarcts

93
Q

Intraretinal microvascular abnormalities (or IrMAs)

A

shunt vessels and appear as abnormal branching or dilation of existing blood vessels (capillaries) within the retina that act to supply areas of non-perfusion in diabetic retinopathy

94
Q

severe non-proliferative diabetic retinopathy criteria

A

“4-2-1”

  • diffuse (traditionally >20) intraretinal hemorrhages in all 4 quadrants,
  • 2 quadrants of venous beading,
  • 1 quadrant of prominent intraretinal microvascular abnormalities (IRMA)
95
Q

IRMAs vs NV in DR

A

IRMAs:

  • larger
  • more broad arrangement
  • intraretinal
  • do not leak on FA
96
Q

signs of ant. uveitis

A
  1. cells and flares in AC
  2. ciliary flush
  3. keratic precipitates(KP)
97
Q

CWSs found in a healthy patient without underlying diabetes or hypertension

A

consider HIV testing

98
Q

Rx of ant. uveitis

A
  1. cycloplegics
  2. topical steroids
  3. systemic steroids(r/o infxn)
  4. glaucoma(avoid pilocarpine)
  5. causes
99
Q

Bilateral recurrent alternating anterior uveitis

A

very characteristic of HLA-B27 uveitis

100
Q

hard drusen vs. soft drusen

A
  1. hard: small, discrete, round, punctate nodules

2. soft: larger, pale yellow or gray, without discrete margins that may be confluent

Eye (3 decks)

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