Block 1- ophthalmology

Question 1

allergic conjunctivitis etiology

Answer 1

Acute or chronic irritation from known allergen, chemical, smoke, etc. All “resolving exposures” (i.e. no chemical burn)

Question 2

allergic conjunctivitis treatment

Answer 2

Allergy Avoidance and Antihistamine or anti-inflammatory eye drops (available OTC also)

Question 3

in allergic conjunctivitis, Eye drops that prevent mast cells from releasing _____ work great…

Answer 3

histamine

Question 4

Cromolyn sodium (generic, Opticrom), nedocromil (Alocril), etc.
 these are examples of \_\_\_\_\_, used  for treatment of allergic conjunctivitis

Answer 4

MAST CELL STABILIZERS

Question 5

Olopatadine (Patanol, Pataday), azelastine HCl (Optivar), ketotifen fumarate (generic, Ketotifen), etc.

these are examples of _____, used for treatment of allergic conjunctivitis

Answer 5

antihistamines

Question 6

PTERYGIUM/ PINGUECULA are both __ growth of tissue

Answer 6

abnormal

Question 7

Abnormal growth of tissue only present over the sclera is _____

Answer 7

pinguecula

Question 8

Abnormal growth of tissue encroaching on the cornea

Answer 8

pterygium

Question 9

eye disorder Most related to chronic environmental irritants; such as hot/sunny/dusty regions…(often found in people who work outside)

Answer 9

PTERYGIUM/ PINGUECULA

Question 10

PTERYGIUM/ PINGUECULA treatment

Answer 10

eye lubrication for comfort (OTC okay)
Surgery for chronic irritation or if becomes intrusive to central vision or obscures large area of peripheral vision
( in short, surgery if encroaching on visual axis)

Question 11

OPEN-angle glaucoma pt history

Answer 11

History—Usually asymptomatic, occasionally “tunnel vision.” Usually gradual onset.
Usually has a family history of 1st degree relative

Question 12

what to expect to see on OPEN-angle glaucoma Physical examination

Answer 12

Elevated IOP (glaucomatous changes can occur with IOPs in the normal range), loss of peripheral vision

Question 13

is Acute CLOSED-angle glaucoma emergent?

Answer 13

yes

Question 14

is open-angle glaucoma emergent?

Answer 14

no

Question 15

Inflammation of the eyelid, can lead to infection, crust is key

Answer 15

BLEPHARITIS

Question 16

BLEPHARITIS

Answer 16

Inflammation of the eyelid, can lead to infection

tx: Eyelid scrubs (need to remove excess oil) & warm compresses (helps physically remove oil)
Consider an antibiotic (ointment>drops & cover staphylococcal infection) for severe cases or refractory symptoms

Question 17

Acute inflammation of the gland or hair follicles of the eyelids
acutely painful

Answer 17

HORDEOLUM (“Stye”)

Question 18

HORDEOLUM (“Stye”)

Answer 18

Acute inflammation of the gland or hair follicles of the eyelids
External type and Internal type
Typically acutely painful

Treatment=
Warm compresses (trying to remove oil that is likely blocking the outlet duct of the hair follicle)
Topical antibiotics if secondary infection develops or refractory symptoms

Question 19

Chronic inflammation of a meibomian gland in the eyelid

painless

Answer 19

CHALAZION

Question 20

CHALAZION

Answer 20

Chronic inflammation of a meibomian gland in the eyelid
Typically / relatively painless
Can progress from a internal hordeolum (chronic)

Treatment?
Warm compresses (key to treatment)
Pt can’t give half-way attempt, as this is so important
Topical antibiotics? (after conservative tx fails)
Specialist Referral
For Incision & drainage? Or BIOPSY? (if all else fails)
Also - May cure on own without intervention

Question 21

ENTROPION / ECTROPION

Answer 21

Turning inward OR outward of the eyelid
Assess location of the eyelashes!!!
Often misdiagnosed as blepharitis

Causes range from old age (lid laxity) to history of trauma, infection, stroke, or facial nerve palsies.

Treatment:
Surgical (if affecting daily life or vision)

Question 22

Turning inward OR outward of the eyelid

Answer 22

ENTROPION / ECTROPION

Question 23

cataract

Answer 23

Any opacification of the lens

Most common cause of blindness worldwide

Most common in the elderly

Presentation: often gradual worsening of vision, “halos” from on-coming car lights or street lights, “glare”, needing brighter lights to read

Treatment is predominantly surgical if conservative measures fail
i.e. avoid excess UV light, wear sunglasses, smoking, diabetes, alcohol abuse

Question 24

Any opacification of the lens

Answer 24

cataract

Question 25

Arcus Senilis

Answer 25

Essentially benign; but patient is concerned “Blue line”… Does not affect vision May be a sign of hyperlipidemia particularly in pt younger than 60 years old

Question 26

Inflammation or infection of the conjunctiva

Answer 26

conjunctivitis

Question 27

CONJUNCTIVITIS

Answer 27

Inflammation or infection of the conjunctiva Etiology? Occur as viral, bacterial, or allergic -mediated ``` Presentation: redness foreign body sensation discharge normal visual acuity normal pupil reactivity ```

Question 28

BACTERIAL CONJUNCTIVITIS

Answer 28

Presentation: - purulent discharge, erythema - usually unilateral Pathogens: Most common: strep, staph, & more rarely gonococcal or chlamydial Treatment Hygiene (don’t rub eyes, wash hands, etc) Warm/cool compresses Topical antibiotics: Old ones (generic) are fine, as many of the new ones are expensive Bacitracin, gentamicin, or erythromycin drops/ointment Alternative treatment if suspecting gonococcus etiology or chlamydia Drops are better during the day, supplemented with ointment at night (ointment during the day can inhibit ADLs, driving, etc) Follow-up – Routine or PRN

Question 29

inflammation of conjunctiva, purulent discharge, erythema | - usually unilateral

Answer 29

BACTERIAL CONJUNCTIVITIS

Question 30

VIRAL CONJUNCTIVITIS

Answer 30

Presentation - ***usually bilateral- spreads from one eye to another - etiology most commonly adenovirus - commonly exposed to others with similar ~Very CONTAGIOUS~ - watery discharge (non-purulent) - itching - local (preauricular) lymphadenopathy often present- key for viral vs bacterial Treatment: - NO SIMPLE Prescription Tx– (pt’s will ask!) - cool compresses - artificial tears as needed - Encourage GOOD HYGIENE!!!!! - SELF- LIMITING regardless of treatment

Question 31

inflammation of conjunctiva,usually bilateral, watery discharge (non-purulent) - itching - local (preauricular) lymphadenopathy often present

Answer 31

VIRAL CONJUNCTIVITIS

Question 32

Allergic Conjunctivitis

Answer 32

Etiology? Acute or chronic irritation from known allergen, chemical, smoke, etc. All “resolving exposures” (i.e. no chemical burn) Treatment= Allergy Avoidance (duh!) and Antihistamine or anti-inflammatory eye drops (available OTC also) Eye drops that prevent mast cells from releasing histamine work great… MAST CELL STABILIZERS - Cromolyn sodium (generic, Opticrom), nedocromil (Alocril), etc. ANTIHISTAMINES- Olopatadine (Patanol, Pataday), azelastine HCl (Optivar), ketotifen fumarate (generic, Ketotifen), etc.

Question 33

pinguecula

Answer 33

``` Abnormal growth of tissue over sclera most commonly nasal side of eye affected more common in tropical climates Most related to chronic environmental irritants; such as hot/sunny/dusty regions…(often found in people who work outside) ``` Treatment / Management: ***eye lubrication for comfort (OTC okay) Surgery for chronic irritation or if becomes intrusive to central vision or obscures large area of peripheral vision ( in short, surgery if encroaching on visual axis)

Question 34

Abnormal growth of tissue | over sclera

Answer 34

pinguecula

Question 35

pterygium

Answer 35

Abnormal growth of tissue encroaching the cornea most commonly nasal side of eye affected more common in tropical climates Most related to chronic environmental irritants; such as hot/sunny/dusty regions…(often found in people who work outside) Treatment / Management: ***eye lubrication for comfort (OTC okay) Surgery for chronic irritation or if becomes intrusive to central vision or obscures large area of peripheral vision ( in short, surgery if encroaching on visual axis)

Question 36

Abnormal growth of tissue encroaching the cornea

Answer 36

pterygium