BRS Ophthalmology Flashcards
visual acuity rapidly improves in the first _____
3-4 months
this is when visual development is most critical and if impaired most likely will result in amblyopia
visual acuity is poor at birth
T
in the range of 20/200
_____ is poor vision caused by abnormal visual stimulus that resultsi n abnormal visual development
2 main categories of things that cause this
amblyopia
eye misalignment like strabismus
any pathologic condition that causes a blurred visual image
significant difference in refractive errors between the eyes
anisometropia
best screening tests to prevent amblyopia
infants: bilateral red reflex test
older kids: formal acuity testing
neonatal conjunctivitis occurs during ______
first month of life
common causes of neonatal conjunctivitis (4)
chemical irritation
neisseria gonorrhea infection
chlamydia trachomatis infection
HSV infection
chemical conjunctivitis during neonatal period usually due to _____
timeline and presentation of this
tx
- 1% silver nitrate > 1% tetracycline and 0.5% erythromycin for gonorrhea ppx
- watery discharge within 24 hours of birth
- no tx needed
purulent eye discharge within 2-4 days of birth
-eyelid swelling
-can lead to corneal ulcer
what is this, conjunctival studies, tx
N gonorrhea infection
gram (-) intracellular diplococci, positive gonococcal culture
IV cefotaxime and topical erythromycin
serous or purulent eye discharge with variable lid swelling within 4-10 days of life
what is this, conjunctival studies, tx
chlamydia trachomatis infection
cytoplasmic inclusion bodies, positive culture
oral erythromycin
unilateral serous discharge within 6 days-2weeks of life
what is this, conjunctival studies, tx
HSV infection
multinucleated giant cells on gram stain, positive HSV culture
IV acyclovir and topical trifluorothymidine
clear tears, enlarged cornea, corneal edema in a newborn
congenital glaucoma
infection of the nasolacrimal sac
dacryocycstitis
infection within the eye itself
endophthalmitis
conjunctivitis assoc with contact use can be 2/2:
allergy to solution
corneal abrasion
bacterial corneal ulcer
causes of unilateral conjunctivitis (3)
foreign body
corneal ulcer
HSV keratitis
causes of bacterial conjunctivitis
nontypeable H flu, strep pneumo, moraxella, staph aureus
purulent eye discharge with minimal itching
no preauricular LAD
often bilateral involvement and sometimes assoc with otitis media
bacterial conjunctivitis
how to tx bacterial conjunctivitis
tx empirically- only get cx and gram stain for severe cases
topical abx: sulfacetamide, polymyxin B, trimethoprim sulfate, gentamicin, tobramycin, erythromycin
URI, pharyngitis, fever, bilateral conjunctivitis
what is it and what is it caused by
pharyngoconjunctival fever- a type of viral conjunctivitis caused by adenovirus types 3 and 7
severe watery conjunctival discharge, hyperemic conjunctiva, preauricular LAD, foreign body sensation
what is and how to tx it?
pharyngoconjunctival fever- a type of viral conjunctivitis
this is highly contagious
tx is supportive- cool compresses, NSAID drops
epidemic keratoconjunctivitis is clinically similar to ________ but sxs are confined to the eyes
which viruses cause this?
pharyngoconjunctival fever
adenovirus types 8, 19, and 37
petechial conjunctival hemorrhage, preauricular LAD, pseudomembrane along the conjunctiva, photophobia from corneal inflammation may be present
lack of fever or pharyngitis
highly contagious
what is it and how to tx?
epidemic keratoconjunctivitis
supportive tx with cool compresses and NSAID drops
skin eruption with multiple vesicular lesions corneal ulcer (rare)
what is it and how to dx and how to tx
primary ocular HSV
- initial exposure to HSV-1
- dx with H&P and positive viral cx or antibody staining
- tx with systemic or topical acyclovir to speed up recovery if administered in first 1-2 days
- topical abx for the skin may prevent secondary bacterial infection
severe or mucoid eye discharge with severe itching
what is it, what’s the pathophys, how to tx?
allergic conjunctivitis
type 1 hypersensitivity reaction
tx: removal of allergens, topical mast cell stabilizing drops (cromolyn), topical antihistamine
what is hemorrhagic conjunctivitis
what are some causes
conjunctivitis + subconjunctival hemorrhage
H flu, adenovirus, picornavirus
____ is eyelid inflammation usually caused by _____ infection
blepharitis
staph aureus
burning, crusting, scales at the eyelid bases, h/o awakening with eyes stuck together
what is it and how to tx
bepharitis
tx with eyelid hygiene (scrub eyelids with baby shampoo), topical erythromycin
watery eye with increased tear lake, matted eyelashes, mucus in the medial canthal area, may be bilateral
nasolacrimal duct obstruction- failure of complete canalization of the lacrimal system that results in obstruction to tear outflow
how to manage nasolacrimal duct obstruction
many resolve by 6 months
nasolacrimal massage
NLD probing if still present at 6-12 months
NLD obstruction often occurs at _____
Hasner’s valve
what is amniotocele/dacryocele
swelling of the nasolacrimal sac 2/2 accumulation of fluid as a result of NLD obstruction
-presents with bluish swelling the medial canthal area
how to manage dacryocele/amniotocele
local massage
if infected, IV abx and urgent NLD probing
retinal hemorrhages are highly suggestive of ______
child abuse
you would see hemorrhagic dots and blots on dilated funduscopic exam
corneal abrasions heal in ______
ophtho consult is needed for ______
24-48 hours
corneal abrasions that are due to contact lens use b/c there is higher risk for corneal ulcer
what is hyphema
what is the most common cause
blood in the anterior chamber
MCC is blunt trauma… others due to iris neovascularization and iris tumors
with hyphema, you may see this on PE
what are some complications
- blood aqueous fluid level
- rebleeding, glaucoma, staining of the cornea with blood, optic nerve damage in kids with SS disease
how to tx hyphema
ophtho consult
bed rest for at least 5 days
blow out fx
what are some clinical features
orbital floor fx
-orbital fat and inferior rectus muscle can be trapped –> diplopia, strabismus, enophthalmos (backward displacement of the globe)
numbness of cheek and upper teeth may occur after ______ 2/2 infraorbital nerve injury
orbital floor fx/blow out fx
how to tx orbital floor fx
empiric oral abx
surgical repair if diplopia persists 2-4 weeks or enophthalmos is bad
intraocular pressure > 30 mmHg at or soon after birth
congenital glaucoma
congenital glaucoma not only results in optic nerve injury but also ________
increased eye size b/c eye wall is much more elastic in infancy
what causes congenital glaucoma
mostly AD inheritance
reduced outflow of aqueous humor 2/2 issues with trabecular meshwork
tearing, photophobia, enlarged cornea, corneal clouding, dull red reflex
congenital glaucoma
how to manage congenital glaucoma
surgery to open outflow channels is almost always required
topical or systemic meds: beta adrenergic and CA inhibitors –> may lower IOP
retinopathy of prematurity (ROP)
proliferation of vessels seen in premature infants exposed to O2
management of ROP
early detection is essential! for little and premies, do a screening funduscopic exam!!
ophtho exam every 1-2 weeks to monitor for progression
minimize amount of O2 delivered
tx hyaline membrane disease
if severe, then do laser therapy
causes of congenital cataracts
- majority are idiopathic
- genetic syndromes: down, noonan, marfan, alport
- nonsyndromic inheritance
- galactosemia, DM
- intrauterine infections (CMV, rubella)
how to manage congenital cataract
early surgery within first weeks of life –> great prognosis
retinoblastoma is a malignant tumor of the sensory retina
- age of presentation
- what’s the etiology/pathophys
- what’s the inheritance
- 13-18 months
- mutation or deletion of a growth suppressor gene on both alleles on the long arm of chromosome 13
- mutations may be sporadic or AR inherited
leukocoria, strabismus, and calcification in the eye should make you think of ______
retinoblastoma
how to dx retinoblastoma
ophthalmoscope exam
ocular US or CT to further evaluate the tumor
how to tx retinoblastoma
- large tumors involving the macula –> removal of entire eye
- smaller tumors –> external beam radiation
- very small peripheral tumors –> cryotherapy or laser photocoagulation
cure rate of retinoblastoma
90%
prognosis is good but you have to catch it!
_______ eye turned nasally
_______ eye turned laterally
esotropia
exotropia
pseudostrabismus
prominence of the epicanthal folds that result in the false appearance of strabismus
what happens if you have strabismus before age 5-7 vs. after age 5-7
before age 5-7 years: amblyopia
after age 5-7 years: diplopia
how to tx amblyopia
ocular patching
glasses
surgery if those 2 don’t work
