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Neurology > 28 Jan 24 Eye Last > Flashcards

28 Jan 24 Eye Last Flashcards

1
Q

Retinal detachment mech

A

Separation of neurosensory layer from underlying retinal pigment epithellium and choroid.
Most commonly caused by posterior vitreous detachment.
When gel like vitreous strongly attached to retina separates.

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2
Q

Retinal detachment CF

A

Can be a complication of eye surgery
Beings in periphery
Peripheral visual field defect progressing centrally
Flashes of light (photopsia)
Vitreous debris (floaters) dark spots or webs.

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3
Q

Examination of Retinal detachment and ttt

A

RAPD
Sluggish pupil in the affected eye
Retinal tears on ophthalmoscopy
Area of gray , elevated retinal (retina hanging in vitreous)
Wrinkled appearance of retina

Ttt:
Retinopexy

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4
Q

RF of retinal detachment

A

Intraocular surgery
Advanced age
Myopia
Ocular trauma.

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5
Q

External hordeolum (stye) location and organism

A

Acute inf disorder of eyelash follicle or tear gland.

Erythematous tender nodule at lid margin.

Within few days a minute pustule appears at lid margin (pointing) which ruptures with discharge of pus or pain relief.

Organism: staph aureus.

Vs internal hordeolum (tender nodule at palpebral conjuctiva- involves meibomian gland)

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6
Q

Ttt of stye

A

Warm compress

Residual granulomatous nodule (chalazion) regresses slowly over several months.

Persistent hordeolum >1-2w
Or large chalazion need incision and drainage.

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7
Q

Baterial keratitis RF and CF

A

Staph , pseudomonas

RF :

 Improper contact lens 
 Corneal trauma , foreign body

Cf :

 Central , round ulcer 
 Stromal abscess 
 Mucopurulent discharge 
 Acute presentation

Eye pain/redness , blurred vision , and photophobia common features of all.

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8
Q

HSV keratitis

A

RF :
Immunocom , HIV

CF :

  UNILATERAL
  Branched dendritic ulcerations 
  Dec corneal sensation 
  Watery discharge 
  Recurrent episodes.

Eye pain/redness , blurred vision , and photophobia common features of all.

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9
Q

Fungal keratitis RF and CF

A

Organism : Candida

RF :

      Immunocomp with corneal injury involving contaminated soil (gardening)

CF :

      Ulcerations with feathery margins and satellite lesions
      Mucopurulent discharge 
      Indolent course

Eye pain/redness , blurred vision , and photophobia common features of all.

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10
Q

infectious keratitis complications

A

Permanent vision impairment
Blindness

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11
Q

Antimicrobials that cause Toxic Optic neuropathy

A

Ethambutol
Chloroquine
Sulfonamides
Linezolid

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12
Q

Ethambutol induced Toxic optic neuropathy mechanism

A

Ethambutol chelates metal ions which interferes with neuronal metabolism .
Impacts glial support cells surrounding optic nerve

Isoniazid use and concurrent vitamin E and B1 def increase risk.

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13
Q

Ethambutol induced toxic neuropathy

A

Progressive painless symmetric loss of visual acuity and color deficits

Central scotoma

Normal fundoscopy (retina is not affected and optic nerve behind eye is involved )

Disc palor a late finding due to optic atrophy

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14
Q

Sjogren syndrome eye Complications

A

Dec visual acuity
Superficial infection
Corneal ulceration
Corneal perforation

(Dec tear volume leads to hyperoamolar state on eye surface causing irritative symptoms and inflammatory response.)

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15
Q

Ttt of sjogren corneal ulceration

A

Artificial tears
Himidifiers
Eyeglasses with occlusive barriers around eye

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16
Q

Diabetic retinopathy types and fundoscopy features.

A

Background/simple diabetic retinopathy:

     Microaneurysms 
     Dot n blot Hemmorrhages 
     Exudates 
     Retinal edema

Preproliferative :

     Cotton wool spots

Proliferative/malignant:

     Neovascularization (fragile and leaky new vessels)
     Retinal hypoxia 
     Inc VEGF

CF: Pts are AS first despite fundoscopic pictures. Visual impairment occurs with development of macular edema.

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17
Q

Ttt to prevent diabetic retinopathy complications

A

Argon laser photocoagulation

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18
Q

CRVO CF and RF

A

Acute UL painless vision loss.
Not as acute as CRAO

RF:

 Coagulopathy
 Hyperviscosity 
 Chronic glaucoma
 Atherosclerotic RF- 
 DM , HTN
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19
Q

Ttt of CRVO

A

Close observation for pts with no sig macular edema / neovascularization

Macular edema is treated with intravitreal inj of VEGF inhibitors

No ttt is effective , vision may partially recover in 3 mo.

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20
Q

CRVO dx

A

Fluoresceine angiography

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21
Q

Blepharitis CF and etiology

A

Inf of eyelid margin

CF : Redness swelling scaling crusting

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22
Q

Dacryocystitis Etiology and CF

A

Acute inf /infection of nasolacrimal sac
(Nasolacrimal duct obstruction causes stasis of tears in nasolacrimal sac)

CF:
Painful swelling and redness around medial epicanthus plus purulent diacharge from punctum.
Normal visual acuity

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23
Q

Hordeolum Etiology CF

A

Extrnal hordeolum (stye) :

Infection of zeis gland

Internal hordeolum:

Infection of meibomian gland.

CF: Tender erythematous nodule/pustule at lid margin(external)
Internal surface of eye (internal)

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24
Q

Chalazion Etiology and CF

A

Granulomatous reaction to obstructed meibomian Gland

CF:

  Solitary , rubbery nodule deep to eyelid margin 
 Painless , common in upper eyelid.
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25
Q

Ttt of dacryocystitis

A

Systemic AB for staph
Incision n drainage of nasolacrimal sac

Untreated can progress to periorbital or orbital cellulitis
Sepsis
Meningitis.

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26
Q

Ttt for open angle glaucoma

A

First line : topical prostaglandin (inc drainage )

Second line : topical BB
( not for asthmatics)

Surgery : laser trabeculoplasty

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27
Q

Triggers for acute ACG

A

Ppl with predisposing anatomy have triggers :

Pupillary dilation events (watching TV , cinema movie , low ambient light)

Medications (decongestants , anticholinergics )

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28
Q

Etiology of ACG

A

Acute rise in IOP

Impaired drainage of aqueous humor thru anterior chamber to the trabecular meshwork at iridocorneal angle.

Inc IOP damages the optic nerve causing permanent vision loss.

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29
Q

Dx of ACG

A

Gold standard :

  Gonioscopy (means iridocorneal angle)

Tonometer: IOP measurment.

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30
Q

Whatbis anterior uvea and posterior uvea

A

Uvea : tissue between cornea/sclera and retina

Anterior uvea : iris and ciliary body (iritis or iridocyclitis)

Posterior uvea. : Choroid.

31
Q

Anterior uveitis CF

A

Ciliary flush (hyperemia at sclera and corneal junction)

Pupillary constriction

Hazy flare in aqueous humor.

Hypopyon

Dec visual acuity.

CF. : Painful red eye
Photophobia
Tearing

32
Q

Cataracts CF

A

Progressive painless blurred vision
Glare
Halos around lights at night (due to scattering light in lens)
Bilateral (may become symptomatic in one eye first)
Initially normal red reflex
Later red reflex lost and retinal detail not visible.

33
Q

Cataract etiology

A

Oxidative damage of lens with aging
Diabetes
Smoking
Chronic sunlight exposure
Glucocorticoid use.

34
Q

Macular degeneration types

A

Atrophic (dry). :

  Slowly progressive 
  Vision loss 
  Scotoma (blind spot)

Exudative /neovascular:

  UL aggressive vision loss 
  Straight line distortion.
35
Q

Bacterial endophthalmitis
Etiology

A

Bacterial infection of aqueous humor or vitreous.

Catarct surgery causes contamination of aqueous humor by conjuctival flora. If communication with vitreous happens during procedure flora seed into vitreous which is much susceptible to infection

36
Q

CF of bacterial endophthamitis

A

👀Dec Vision +_ eye discomfort (ache)
👀Conjuctival inj & edema
👀Purulent haziness or layering of leukocytes (hypopyon) in anterior chamber.

37
Q

DX Ttt of endophthalmitis

A

Dx : Clinical

Ttt:

    Intravitreal inj of AB
    Vitrectomy fr severe cases
38
Q

Pt with traumatic eye develops inflammation and dec vision in uninjured eye

A

Sympathetic ophthalmia.

39
Q

Etiology of sympathetic ophthalmia

A

Self antigens from site of injury release bcz of trauma
T cells (autoreactive) recognize these antigens as foreign and initiate inf response against normal and injured eye.

40
Q

Ttt of symapthetic ophthalmia

A

Surgery : enucleation if injured eye doesnt recover (to prevent blindness kn normal eye).

Close follow up on healthy eye if pt recovers. From injury

If both eyes affected : steroid and monoclonal Ab to dec inflammation

41
Q

Ocular manifestations of HIV

A

Cataracts
CMV retinitis
HSV keratitis
Uveitis
Neurophthalmic complications.

42
Q

Cause of cataract at young age

A

Diabetes
Ocular trauma
Glucocorticoid use
External radiation
Chronic HiV

43
Q

Ttt of cataract

A

Prosthetic lens.

44
Q

Candida endophthalmitis cause

A

RF :

  Indwelling central catheter 
  TPN
  BS antibiotic 
  GI surgery
  Immunocomp
  Hosp ptsbwith recent eye surgery or trauma
45
Q

Candida endophthalmitis mech

A

Transient/persistent fungemia spreads to highly vascular choroid layer via hematogenous spread ➡️ invasion of retina

46
Q

CF of candida EO

A

UL floaters and progressive vision loss
Pain rare until later in dx
No fever
Dec visual acuity

47
Q

Fundscopy of candida EO

A

Fluffy
Yellow white mound like lesions with indistint borders

48
Q

DX of Candida EO

A

Blood cuktures (often negative)
Vitreous sampling and culture

49
Q

Ttt of candida EO

A

Systemic antifungal
Vitrectomy + vitreous inj

50
Q

Corneal abrasion CF

A

Pain
Tearing
Photophobia
Foreign body sensation
Conjuctival erythema

51
Q

Dx of corneal abrasion

A

Fluorescein dye

52
Q

Ttt of corneal abrasion (contact lens)

A

Topical Antipseudomonal
(Ofloxacin , ciprofloxacin ,tobramycin)
Avoid lens use.
Follow up in 24hrs for corneal infiltrate/ulcer

(Avoid eye patch can abrade cornea further )

Complication; Ulcer of cornea.

53
Q

Ttt of corneal abrasion from trauma/foreign body (non lens)

A

Remove foreign body by irigation
Topical AB
(Erythromycin , polymyxin / trimethoprim)

No followup for <3mm defect with improve SS , normal vision , no foreign body.

54
Q

Open globe injury CF

A

Extrusion of vitreous (gush of fluid)
Eccentric or teardrop pupil
Dec visual acuity
RAPD
Dec IOP

55
Q

Ttt of open globe injury

A

Emergency eye consult
Eye shield
CT scan of eye
IV AB
Tetanus prophylaxis

56
Q

Cause of open globe injury

A

High velocity projectile injury
Metal shards
Weapons
Lawn mower
Motor vehicle accidents

57
Q

Chemical burns SS

A

Eye pain
Blepharospasm
Gritty sensation
Eye erythema
Eye may even look white

58
Q

Acidic vs alkali burns

A

Acid :
Coagulative necrosis
Makes eschar
Prevents acid from causing further injury

Alkali (bleach) :

     Liquefactive necrosis 
     Cell mem dissolution 
     Deeper penetration of tissues 
     Severe injury
59
Q

Ttt of chemical burn

A

Continuous irrigation (with eye wash device) to neutralize ph for
30-60 mins

May take >2hr for alkali

60
Q

Signs of Open Globe Injury

A

Visible entry wound
Globe deformity
irregularly shaped pupil

61
Q

Corneal abrasion vs OGI

A

Dx with flurescein test

Corneal abrasion :

    Discrete area of adherent fluoresein

OGI :

     Concentrated dye uptake with subsequent clearing (waterfall pattern) - full thickness corneal laceration with OGI  (Seidel sign )    Oph emergency

In the absence of obvious OGI SS further corneal assessment is done by fluorescein staining.

62
Q

Complications of traumatic hyphema

A

Rebleeding
Intraocular HTN ➡️ optic nerve atrophy
Permanent vision loss.

63
Q

Mechanism of injury traunatic hyphema

A

Blunt ocular trauma ( baseball , airbag deployment )

Penetrating trauma (less common)

64
Q

CF of traumatic hyphema

A

Blood in anterior chamber
Vision loss
Eye pain
Photophobia
Anisocoria (unequal pupils)

65
Q

ttt of traumatic hyphema

A

Oph consult
Monitor IOP (fear of optic nerve injury and permanent vision loss)
Cycloplegic and steroid eye drops

Eye shield

Bed rest. (Head elevation)

66
Q

Orbital compartment syndrome cause

A

Trauma (most imp)
Coagulopathy
Infection
Surgery

67
Q

Orbital Compartment syndrome PE

A

Rapid inc in orbital pressure leads to

Periorbital swelling ecchymosis
Tightness
Proptosis
Diffise subconjuctival hem
Limited EOM
RAPD. (optic nerve injury and ischemia due to compression)

68
Q

Ttt of OCS

A

Clinical Dx

Immediate surgical decompression
To preserve vision (prior to any imaging do surgery)

Procedure: lateral canthotomy

69
Q

Steroid induced glaucoma (OAG) cause

A

Steroid eye drops

  Systemic and topical steroid dec aqueous humor outflow acting on trabecular meshwork.
70
Q

RF of steroid induced glaucoma

A

🛖Personal and family history of OAG (anatomically predisposed)

🛖DM , Connective tissue dx , myopia

71
Q

SS of steroid induced ocular HTN

A

SS occur in advanced disease

Rapid IOP inc causes
Halos around light
Dec visual acuity
Eye pain
Headache
Corneal edema (ACG)

72
Q

Ttt of steroid induced IOP

A

Monitor to detect Inc IOP before OAG develops

Steroid cessation (returns IOP to normal)

persistently inc IOP : Antiglaucoma medications topical

Refractory cases: Laser trabeculoplasty or surgical trabeculectomy

73
Q

Pts using long term glucocorticoids have vision loss , glare in sunlight , lens opacity.

A

Subcapsular cataracts due to steroids

Neurology (19 decks)

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