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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
Ttt of dacryocystitis
Systemic AB for staph Incision n drainage of nasolacrimal sac Untreated can progress to periorbital or orbital cellulitis Sepsis Meningitis.
26
Ttt for open angle glaucoma
First line : topical prostaglandin (inc drainage ) Second line : topical BB ( not for asthmatics) Surgery : laser trabeculoplasty
27
Triggers for acute ACG
Ppl with predisposing anatomy have triggers : Pupillary dilation events (watching TV , cinema movie , low ambient light) Medications (decongestants , anticholinergics )
28
Etiology of ACG
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.
29
Dx of ACG
Gold standard : Gonioscopy (means iridocorneal angle) Tonometer: IOP measurment.
30
Whatbis anterior uvea and posterior uvea
Uvea : tissue between cornea/sclera and retina Anterior uvea : iris and ciliary body (iritis or iridocyclitis) Posterior uvea. : Choroid.
31
Anterior uveitis CF
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
Cataracts CF
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
Cataract etiology
Oxidative damage of lens with aging Diabetes Smoking Chronic sunlight exposure Glucocorticoid use.
34
Macular degeneration types
Atrophic (dry). : Slowly progressive Vision loss Scotoma (blind spot) Exudative /neovascular: UL aggressive vision loss Straight line distortion.
35
Bacterial endophthalmitis Etiology
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
CF of bacterial endophthamitis
👀Dec Vision +_ eye discomfort (ache) 👀Conjuctival inj & edema 👀Purulent haziness or layering of leukocytes (hypopyon) in anterior chamber.
37
DX Ttt of endophthalmitis
Dx : Clinical Ttt: Intravitreal inj of AB Vitrectomy fr severe cases
38
Pt with traumatic eye develops inflammation and dec vision in uninjured eye
Sympathetic ophthalmia.
39
Etiology of sympathetic ophthalmia
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
Ttt of symapthetic ophthalmia
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
Ocular manifestations of HIV
Cataracts CMV retinitis HSV keratitis Uveitis Neurophthalmic complications.
42
Cause of cataract at young age
Diabetes Ocular trauma Glucocorticoid use External radiation Chronic HiV
43
Ttt of cataract
Prosthetic lens.
44
Candida endophthalmitis cause
RF : Indwelling central catheter TPN BS antibiotic GI surgery Immunocomp Hosp ptsbwith recent eye surgery or trauma
45
Candida endophthalmitis mech
Transient/persistent fungemia spreads to highly vascular choroid layer via hematogenous spread ➡️ invasion of retina
46
CF of candida EO
UL floaters and progressive vision loss Pain rare until later in dx No fever Dec visual acuity
47
Fundscopy of candida EO
Fluffy Yellow white mound like lesions with indistint borders
48
DX of Candida EO
Blood cuktures (often negative) Vitreous sampling and culture
49
Ttt of candida EO
Systemic antifungal Vitrectomy + vitreous inj
50
Corneal abrasion CF
Pain Tearing Photophobia Foreign body sensation Conjuctival erythema
51
Dx of corneal abrasion
Fluorescein dye
52
Ttt of corneal abrasion (contact lens)
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
Ttt of corneal abrasion from trauma/foreign body (non lens)
Remove foreign body by irigation Topical AB (Erythromycin , polymyxin / trimethoprim) No followup for <3mm defect with improve SS , normal vision , no foreign body.
54
Open globe injury CF
Extrusion of vitreous (gush of fluid) Eccentric or teardrop pupil Dec visual acuity RAPD Dec IOP
55
Ttt of open globe injury
Emergency eye consult Eye shield CT scan of eye IV AB Tetanus prophylaxis
56
Cause of open globe injury
High velocity projectile injury Metal shards Weapons Lawn mower Motor vehicle accidents
57
Chemical burns SS
Eye pain Blepharospasm Gritty sensation Eye erythema Eye may even look white
58
Acidic vs alkali burns
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
Ttt of chemical burn
Continuous irrigation (with eye wash device) to neutralize ph for 30-60 mins May take >2hr for alkali
60
Signs of Open Globe Injury
Visible entry wound Globe deformity irregularly shaped pupil
61
Corneal abrasion vs OGI
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
Complications of traumatic hyphema
Rebleeding Intraocular HTN ➡️ optic nerve atrophy Permanent vision loss.
63
Mechanism of injury traunatic hyphema
Blunt ocular trauma ( baseball , airbag deployment ) Penetrating trauma (less common)
64
CF of traumatic hyphema
Blood in anterior chamber Vision loss Eye pain Photophobia Anisocoria (unequal pupils)
65
ttt of traumatic hyphema
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
Orbital compartment syndrome cause
Trauma (most imp) Coagulopathy Infection Surgery
67
Orbital Compartment syndrome PE
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
Ttt of OCS
Clinical Dx Immediate surgical decompression To preserve vision (prior to any imaging do surgery) Procedure: lateral canthotomy
69
Steroid induced glaucoma (OAG) cause
Steroid eye drops Systemic and topical steroid dec aqueous humor outflow acting on trabecular meshwork.
70
RF of steroid induced glaucoma
🛖Personal and family history of OAG (anatomically predisposed) 🛖DM , Connective tissue dx , myopia
71
SS of steroid induced ocular HTN
SS occur in advanced disease Rapid IOP inc causes Halos around light Dec visual acuity Eye pain Headache Corneal edema (ACG)
72
Ttt of steroid induced IOP
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
Pts using long term glucocorticoids have vision loss , glare in sunlight , lens opacity.
Subcapsular cataracts due to steroids

Neurology (19 decks)

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