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Neurology > 26 Jan 24 Eye > Flashcards

26 Jan 24 Eye Flashcards

1
Q

RF for orbital cellulitis

A

Local infection:

 Sinusitis 
 Dental infection (maxillary teeth) 
 Skin infection

Orbital trauma

🧇 for orbital cellulitis due to dental abscess always check the side of teeth and eye involvement should be same saide and only maxillary teeth can cause orbital cellulitis

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2
Q

Orbital cellulitis CF

A

Painful eye movements
Ophthalmoplegia
Proptosis
Visual changes

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3
Q

Orbital cellulitis Pathophys

A

Proximity of sinuses to orbital space allows contiguous spread of bacteria (strept. Staph) during episodes of severe sinusitis.
The infection causes inf of extraocular muscles (ophthalmoplegia , painful eye movements) and orbital fat (proptosis)

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4
Q

OC management

A

DX :

 Clinical 
 Uncertain cases  CT orbit and sinuses (to identify drainable fluid collections in orbit)

 IV antibiotics 

 Surgical drainage
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5
Q

Preseptal cellulitis cause

A

Preseptal cellulitis is an infection anterior to orbital septum

Cause :

Breaks in skin due to inf (atopic dermatitis )

Trauma (insect bite)

No proptosis , visual change or ophthalmoplegia

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6
Q

Pt with esotropia and asymmetric red reflexes

A

Strabismus / ocular misalignment

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7
Q

Examination of strabismus

A

Asymmetric corneal light reflex
Asymmetric red reflex (more intense in deviated eye)
Cover test: Misaligned eye shifts to refixate on object. Normal maintain same position without moving.

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8
Q

DIagnostic workup of strabismus….

A

Dilated fundoscopy exam : for secondary causes

 Retinoblastoma

MRI to confirm retinoblastoma

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9
Q

Cause of strabismus

A

Idiopathic
Intraorbital mass (retiniblastoma)
Inc ICP

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10
Q

Why is it imp to treat strabismus

A

Can cause amblyopia
Dec visual acuity of affected eye

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11
Q

Retinoblastoma CF

A

Diagnosed in age <2
Any child with absent red reflex
White pupillary reflex (leukocoria)
Inactivation if RB1 gene
Sporadic is UL
Genetic BL

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12
Q

CF of retinoblastoma

A

Strabismus
Nystagmus
Vision impairment
Ocular inflamation

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13
Q

Dx workup of RB

A

MRI of orbits and brain
(Biopsy not done due to risk of seeding )

Immediate Referral to avoid mets to CL eye and brain.

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14
Q

What is Amblyopia

A

Functional reduction in visual acuity in one or both eyes due to vision disturbance in early childhood

UL (most common) : >2 line diff in vision between eyes

BL : vision worse than 20/40 at age >4

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15
Q

Causes of amblyopia

A

Strabismus
Asymmetric Refractive error
Vision deprivation (cataracts , ptosis)

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16
Q

Management of amblyopia

A

▶️ corrective lens
▶️ encourage use of amblyopic eye
Patching eye with better vision
Cycloplegic drops to blur normal eye

▶️ surgery ; cataract removal

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17
Q

Pathophys of Amblyopia

A

Occurs when visual system is developing
Age <5 . During early childhood dec visual stimuli from one eye results in preferentially enhanced developmentbof visual cortex ass with the other normally functioning eye and further decreased visual acuity of the affected eye.

Because of compensation from normal eye , amblyopia from an uncorrected refractive error maynot present until normal eye is occluded(pirate patch in children)

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18
Q

Ttt of amblyopia

A

Corrective lens

Envourage use of amblyopic eye
Patching eye with better vision
Cycloplegic drops to blur normal eye
Surgery
(Remove cataract )
Without ttt vision loss becomes permanent

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19
Q

Myopia (near sightedness) pathophys

A

Causes by inc axial length of eye (most common) or corneal protrusion

Refracted image is focused anterior to retina.

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20
Q

Myopia incidence

A

New onset incidence highest in adolescents

Severity typically stabilizes by early adulthood

RF: positive FH ,
East Asian descent

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21
Q

Myopia CF

A

Blurred distant vision
Normal near vision

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22
Q

Ttt of myopia

A

Prescription lenses with diverging (concave) lens , refocusing the refracted image onto retina.

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23
Q

Examination of Myopia

A

Dec visual acuity
Normal peripheral field testing
Fundoscopy normal

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24
Q

Complication in uncorrected or refractory myopia

A

Progressive myopia leads to high myopia
Needing >6 diopters of correction to achieve normal visual acuity

High myopia stretches and thins retina choroid and sclera
These changes causes RETINAL detachment and macular degeneration ➡️ vision loss.

Retinal detachment➡️ retinal tear that allows vitreous fluid to accumulate between retina and choroid

🛞 in some children antimuscrinic drops (atropine ) and orthokeratology (rigid contact lens) mayb used to slow progressive myopia and prevent subsequent complications.

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25
Q

Hyphema

A

Blood in anterior chamber due to bkunt forced trauma

26
Q

Chemical conjuctivitis onset , findings , ttt

A

Age of onset : <24hrs

CF :

    Mild conjuctival irritation and tearing 
    Uncommon adverse effect of topical erythromycin

Ttt:

   Artificial tears.
27
Q

Gonococcal conjuctivitis onset , Cf , ttt

A

Onset: 2-5days

CF :

  Profuse purulent discharge 
  Marked conjuctival injection, and eyelid edema

Ttt:

  IM/IV cefotaxime (single dose)
28
Q

Chlamydial conjuctivitis onset , CF , ttt

A

Onset : 5-14 days

CF:

  Watery , serosanguineous or mucopurulent eye discharge 
  Mild eyelid swelling

Ttt:

  Oral erythromycin

🎱monitor patients for pyeloric stenosis a potent adverse effect of oral macrolides in infants.

29
Q

Dacryocystitis Cause

A

Infection of lacrimal sac
Causes purulent discharge
Erythema and swelling and tenderness over lacrimal sac at MEDIAL CANTHUS of affected eye

30
Q

Why we do oral(systemic) macrolides for chlamydia and not topical ?

A

Chlamydia perinatal transmission leads to colonization of nasopharynx plus conjuctivitis.

Topical erythmromycin has high failure rate and colonization if nasopharynx cant be treated.

Hence oral erythromycin

31
Q

Congenital Dacryostenosis

A

NLD obstruction due to incomplete canalization of distal duct in utero leading to persistent membrane that blocks tear drainage from NLD to nose.

Tears flow out of lacrimal sac back into eye (inc tearing or mucoid discharge)

32
Q

Congenital dacryostenosis CF

A

Intermittent or chronic tearing , mucoid discharge

Eyelash crusting/matting

Absence of conjuctival injection

33
Q

Ttt of Dacryostenosis

A

Lacrimal sac massages
Reassurance (resolution by 6-12mo)
Persistent obstruction➡️ NLD probing

34
Q

Complications of Dacrysostenosis

A

Distension of lacrimal Sac/duct (dacryocystocele)

Infection of lacrimal duct/sac (dacryocystitis)

35
Q

Photokeratitis cause and prevention

A

UV light causes desquamation of corneal epithellium

RF: High altitudes , areas with inc UV light reflection(sand,water , snow)

Prevention: UV glasses

36
Q

Photojeratitis CF

A

👀 severe , BL eye pain and phoyophobia 6-12hr after exposure

👀 foreign body sensation in eye

👀 dec vision

👀 conj erythema , chemosis , tearing

37
Q

Photokeratitis Dx

A

Punctate corneal staining with fluorescein dye

38
Q

Ttt of photokeratitis

A

Supportive (oral analgesics , topical AB)

Symptom resolution in 1-3 days

39
Q

UV radiation related eye dx

A

Photokeratitis
Pterygium
Cataracts

40
Q

Fuoresceine dye showing discrete UL linear stain ….dx

A

Foreign body

41
Q

When should vision be evaluated in child routine evaluation

A

4years.

3years in co operative children

42
Q

When is autism evaluated in routine?

A

Age 18months and 2years.

43
Q

When is despression screening done ?

A

Age 12.

44
Q

Trachoma CF

A

Stage 1 (active):

  Inflammation of upper tarsal conjuctiva 
  Follicular conjuctivitis 
  White yellow follicles on inflammed        tarsal conjuctiva
  Pts have mild itchiness , redness or discharge.

Stage 2 (scarring):

      Scarring of upper tarsal conjuctiva and trichiasis

Stage 3:

As lashes rub the eye ➡️painful ulcerations ➡️eventually Corneal opacity and blindness
45
Q

Trachoma causative agent

A

Chlamydia trachomatis (A,B,C)

   🎗Genital infection serotypes (D , K)
46
Q

DX of trachoma.

A

Clinical exam of tarsal conjuctiva

(Leading cause of blindness worldwide)

47
Q

Ttt of trachoma

A

Acute infection is self limiting

Oral azithromycin for patient and all contacts to limit the dx and limit the spread.

48
Q

Adenoivral keraticonjuctivitis CF

A

Preceded by URTI
Severe ocular pain
Photophobia
Corneal abrasions on exam

49
Q

Optic nerve injury mechanism and CF

A

🚑Facial trauma
on blow to face shearing forces are transmitted to optic canal causing avulsion of nerve in the optic canal.

🚑Penetrating eye trauma (needle puncture during eye surgery)

CF:

    Acute vision loss (dec visual acuity) 
    Dec color vision 
    RAPD
50
Q

DX of optic nerve injury

A

CT scan if orbit

51
Q

Ttt of optic nerve injury

A

Urgent Ophthalmology referral
Surgical decompression

Poor initial visual acuity (loss of light perception) is ass with worse prognosis.

52
Q

Strabismus (ocular misalignment)
CF

A

⚽️Constant eye deviation at any age
Nasal (esotropia) temporal (exotropia)

⚽️Intermittent eye deviation at any age >4mo
⚽️Eye deviation on cover test
⚽️A/S corneal light reflexes
⚽️A/S intensity of red reflexes
⚽️Torticollis or head tilt

53
Q

Ttt of strabismus

A

Strengthen deviated eye
(Patch unaffected eye , cycloplegic drops to blur unaffected eye )

Correct refractive error

Surgery

54
Q

Complication of strabismus

A

Amblyopia
Diplopia

55
Q

Strabismus cause in paeds

A

<4mo due to immature EOM in infants.
>4mo is treated to prevent amblyopia

Cause ;
Idiopathic
IO mass (RB)
Inc ICP

56
Q

Strabismus screen

A

Screening is done until 5years at every visit.
(Early ttt has best results as Visual cortex is most malleable)

57
Q

CF of optic pathway glioma (NF1)

A

UL vision loss
Proptosis
Esotropia
Optic disc pallor

NF1;
Freckling of skinfold
Cafe au lait macules
Lisch nodules
Neurofibromas

58
Q

Lens dislocation(ectopia lentis) cause

A

🍔detachment of lens from ciliary body
🍔 blunt ocular trauma (forceful projectile)
🍔 genetic condition (marfan)

59
Q

CF of ectopia lentis

A

Painless vision loss
Tremulous iris with eye movement
Lens displacement on slitlamp exam

60
Q

Ttt of ectopia lentis

A

Glasses to correct refractive error

Surgical correction

Assessment for underlying condition if lens dislocated on mild trauma (marfan)
Screen for marfan with Echo for aortic root disease.
As it can be first presentation for marfans

61
Q

Ass conditions in ectopia lentis

A

Hemocytinuria (intellectual diability, thrombotic events)

Marfan ( high myopia , marfanoid habitus , ectopia lentis)

Neurology (19 decks)

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