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ophtho > Chapters 4-6 > Flashcards

Chapters 4-6 Flashcards

1
Q

what does “red eye” specifically reference

A

“hyperemia”–> which is injection of the superficially visible vessels of the conjunctiva, episclera or sclera

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2
Q

list some disorders that can cause red eye

A

acute angle closure glaucoma

iritis or iridocyclitis

herpes simplex keratitis

conjunctivitis

episcleritis

soft contact lenses

scleritis

adnexal disease

subconjunctival hemorrhage

pterygium

keratoconjunctivitis sicca

abrasion

corneal ulceration

secondary to abnormal eyelid function

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3
Q

is the following cause of red eye serious?

acute angle closure glaucoma

A

yes

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4
Q

is the following cause of red eye serious?

keratoconjunctivitis sicca

A

no

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5
Q

is the following cause of red eye serious?

subconjunctival hemorrhage

A

rarely

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6
Q

is the following cause of red eye serious?

iritis or iridocyclitis

A

yes

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7
Q

is the following cause of red eye serious?

conjunctivitis

A

no

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8
Q

is the following cause of red eye serious?

herpes simplex keratitis

A

yes

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9
Q

is the following cause of red eye serious?

episcleritis

A

no

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10
Q

is the following cause of red eye serious?

soft contact lenses

A

yes

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11
Q

does chronic open angle glaucoma cause red eye

A

no

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12
Q

what is acute angle closure glaucoma

A

sudden, complete occlusion of the anterior chamber by iris tissue

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13
Q

what is iritis or iridocyclitis

A

inflammation of the iris alone or of the iris and the ciliary body

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14
Q

how does iritis or iridocyclitis manifest

A

as ciliary flush –> violet discoloration visible behind the limbus

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15
Q

what is herpes simplex keratitis

A

infection of the cornea caused by herpes simplex virus–> common and potentially serious

can lead to corneal ulceration or scarring

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16
Q

how does herpes simplex keratitis present on exam

A

characteristic dendrites on corneal epithelium

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17
Q

what is conjunctivitis

A

hyperemia of the conjunctival blood vessels–> due to bacterial, viral or allergic causes

itching is a feature of allergic conjunctivitis but not bacterial or viral

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18
Q

what is episcleritis

A

inflammation of the episclera (vascular later between conjunctiva and sclera)

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19
Q

how does episcleritis present

A

no discharge

not serious

possible allergic and tender over inflamed area

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20
Q

why do soft contact lenses cause red eye

A

poor fit or poor hygiene

can lead to serious vision threatening infection of the cornea

made referral due to subtle slit lamp findings –> subacute follow up for subtle findings

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21
Q

what is scleritis

A

inflammation (localized or diffuse) of the sclera

uncommon, often protracted and usually accompanied by severe pain

violaceous hue of the sclera may indicate a serious systemic disease i.e collagen vascular disease

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22
Q

what is adnexal disease

A

affects eyelids, lacrimal apparatus and orbit

includes dacrocyctitis, stye and blepharitis

red eye can also occur secondary to lid lesions (BCC, SCC, molluscum contagiosum), thyroid disease or vascular lesions of the orbit

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23
Q

name examples of adnexal disease

A

dacrocystitis

stye

blepharitis

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24
Q

what is subconjunctival hemorrhage

A

accumulation of blood in the potential space between the conjunctiva and the sclera

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25
Q

what is pterygium

A

abnormal growth that advances progressively across the cornea, usually from the nasal side across

more common in people from places where there is intense sun every day

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26
Q

what is keratoconjunctivitis sicca

A

dry eye

disorder involving the conjunctiva and sclera resulting in a lacrimal deficiency

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27
Q

what is a corneal ulceration

A

loss of integrity of the corneal epithelium due to inflammation or infection which can result in ulcer with associated hyperemia

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28
Q

what does the cornea look like in corneal ulceration? what are other symptoms?

A

hazy or white in the area of the ulcer

associated with mucus secretions in the eye and pain and photophobia

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29
Q

list the 9 diagnostic steps for a patient with a red eye

A
  1. determine visual acuity as normal or decreased
  2. inspect pattern of redness–> subconjunctival hemorrhage, conjunctival hyperemia, ciliary flush or a combo
  3. detect pattern of discharge–> profuse or scant and purulent, mucopurulent or serous
  4. detect opacities of the cornea and irregular corneal reflection
  5. look for disruption of the corneal epithelium using FLUORESCEIN
  6. estimate the depth of the anterior chamber as normal or shallow and detect any layered blood or pus
  7. detect irregularity of the pupils and observe the reactivity of the pupils to light
  8. tonometry of angle closure glaucoma is suspected
  9. detect presence of proptosis, lid malfunction or any limitations of eye movement
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30
Q

list the 9 diagnostic steps for a patient with a red eye

A
  1. determine visual acuity as normal or decreased
  2. inspect pattern of redness–> subconjunctival hemorrhage, conjunctival hyperemia, ciliary flush or a combo
  3. detect pattern of discharge–> profuse or scant and purulent, mucopurulent or serous
  4. detect opacities of the cornea and irregular corneal reflection
  5. look for disruption of the corneal epithelium using FLUORESCEIN
  6. estimate the depth of the anterior chamber as normal or shallow and detect any layered blood or pus
  7. detect irregularity of the pupils and observe the reactivity of the pupils to light
  8. tonometry of angle closure glaucoma is suspected
  9. detect presence of proptosis, lid malfunction or any limitations of eye movement
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31
Q

what should you suspect in a patient with a red eye that presents also with:

headache, tearing, halos

A

acute angle closure glaucoma

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32
Q

what should you suspect in a patient with a red eye that presents also with:

characteristic dendrites on corneal epithelium

A

herpes simplex keratitis

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33
Q

what should you suspect in a patient with a red eye that presents also with:

no discharge, not serious, tender over inflamed area

A

episcleritis

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34
Q

what should you suspect in a patient with a red eye that presents also with:

ciliary flush

A

iritis or iridocyclitis

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35
Q

what should you suspect in a patient with a red eye that presents also with:

itching

A

allergic conjunctivitis

bacterial and viral do not itch

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36
Q

what should you suspect in a patient with a red eye that presents also with:

protracted course accompanied by often severe pain

A

scleritis

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37
Q

what should you suspect in a patient with a red eye that presents also with:

violaceous hue of the sclera

A

scleritis that may be due to a serious underlying systemic disorder like collagen vascular disease

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38
Q

what should you suspect in a patient with a red eye that presents also with:

abnormal growth progressing across cornea from nasal side

A

pterygium

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39
Q

what should you suspect in a patient with a red eye that presents also with:

dry eye

A

keratoconjunctivitis sicca

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40
Q

what should you suspect in a patient with a red eye that presents also with:

hazy or white cornea in one area, with possible mucus secretions in the eye and pain and photophobia

A

corneal ulcer

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41
Q

what should you suspect in a patient with a red eye that presents also with:

poor lid closure

A

secondary to poor lid function

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42
Q

list the DANGER signs of a red eye

A

blurred vision

severe pain

photophobia

coloured halos

reduced visual acuity

ciliary flush

corneal opacification

corneal epithelial disruption

pupillary abnormalities

shallow anterior chamber

elevated IOP

proptosis

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43
Q

in a patient with a red eye, what does the following danger sign suggest:

blurred vision

A

if improves with blinking then suggests discharge or mucus on the ocular surface

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44
Q

what should you suspect in a patient with a red eye that presents also with:

severe pain

A

may indicate keratitis, ulcer, iridocyclitis, scleritis or acute glaucoma

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45
Q

what should you suspect in a patient with a red eye that presents also with:

photophobia

A

iritis

can be alone or secondary to corneal infiltration

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46
Q

what should you suspect in a patient with a red eye that presents also with:

coloured halos

A

these are rainbow like fringes around a point of light

usually a symptom of CORNEAL EDEMA from an abrupt rise in IOP

suspect acute glaucoma

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47
Q

what should you suspect in a patient with a red eye that presents also with:

reduced visual acuity

A

suggests SERIOUS ocular disease such as inflamed cornea, iridocyclitis, or glaucoma

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48
Q

does reduced visual acuity ever occur with simple conjunctivitis?

A

no not unless there is associated corneal involvement

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49
Q

what should you suspect in a patient with a red eye that presents also with:

ciliary flush

A

this is injection of the deep conjunctival and episcleral vessels surrounding the cornea –> faint VIOLACEOUS RING around the iris

danger sign for:
corneal inflammation
iridocyclitis
acute glaucoma

usually not present in conjunctivitis

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50
Q

what should you suspect in a patient with a red eye that presents also with:

corneal opacification

A

ALWAYS DENOTES DISEASE

there are several types:

  1. keratitis precipitates or cellular deposits–> can result from iritis or chronic iridocyclitis
  2. diffuse haze characteristic or corneal edema (acute glaucoma)
  3. localized opacities from keratitis or ulcer
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51
Q

what disease is associated with corneal edema

A

acute glaucoma

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52
Q

what disease is associated with corneal edema

A

acute glaucoma

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53
Q

what should you suspect in a patient with a red eye that presents also with:

corneal epithelial disruption

A

occurs in corneal inflammation and trauma

can visualize it best with fluorescein

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54
Q

what should you suspect in a patient with a red eye that presents also with:

pupillary abnormalities

A

the pupil in the eye affected with iridocyclitis is somewhat SMALLER that in the other eye due to REFLEX SPASM of the iris sphincter muscle

in acute glaucoma, the pupil is fixed, mid dilated and slightly irregular (5-6 mm)

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55
Q

does conjunctivitis affect the pupil

A

NO

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56
Q

how does iridocyclitis affect the pupil

A

the pupil in the eye affected with iridocyclitis is somewhat SMALLER that in the other eye due to REFLEX SPASM of the iris sphincter muscle

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57
Q

what should you suspect in a patient with a red eye that presents also with:

shallow anterior chamber

A

suggests acute angle closure glaucoma

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58
Q

what should you suspect in a patient with a red eye that presents also with:

elevated IOP

A

if low elevation–> iridocyclitis

if high elevation–> glaucoma

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59
Q

what should you suspect in a patient with a red eye that presents also with:

proptosis

A

this is forward displacement of the globe

sudden proptosis suggests serious orbital or cavernous sinus disease

most common cause of chronic proptosis is thyroid disease

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60
Q

what is the most common cause of chronic proptosis

A

thyroid disease

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61
Q

what should you rule out in the setting of sudden proptosis

A

suggests serious orbital or cavernous sinus disease

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62
Q

list the non urgent findings that can be associated with red eye

A

exudation–> “mattering”

itching

conjunctival hyperemia

discharge

pre-auricular lymph node enlargement

blepharitis

stye and chalazion

subconjunctival hemorrhage

conjunctivitis

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63
Q

what does red eye and exudation typically result from

A

from conjunctival or eyelid inflammation and does NOT occur with iridocyclitis or glaucoma

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64
Q

does red eye and EXUDATION occur with iridocyclitis or glaucoma

A

no

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65
Q

does corneal ulceration have exudate?

A

it may or may not–> if have exudates in setting of corneal abrasion, it is urgent

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66
Q

what is conjunctival hyperemia

A

engorgement of the larger and more superficial bulbar conjunctival vessels

non specific sign

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67
Q

how can discharge be used as a clue to the cause of a conjunctivitis

A

purulent (creamy-white) or mucopurulent (Yellow) suggests BACTERIAL

serous (watery/clear) suggests VIRAL

scant, white, stringy discharge suggests ALLERGIC or DRY EYE

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68
Q

what do pre-auricular lymph nodes enlarged in the setting of red eye indicate

A

frequent sign of viral conjunctivitis (usually not present in bacterial conjunctivitis)

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69
Q

what is blepharitis

A

inflammation of the eyelife

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70
Q

how should you manage chronic, unilateral blepharitis

A

refer to ophtho to rule out malignant process

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71
Q

what is the most likely cause of blepharitis of the anterior aspect of the lid

A

staphylococcal blepharitis

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72
Q

what is the most likely cause of blepharitis of the posterior aspect of the lid

A

rosacea blepharitis

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73
Q

what is another word for a stye/chalazion

A

hordeolum

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74
Q

what are styes/chalazions

A

usually sterile inflammation of the glands or hair follicles in the eyelids

can be categorized as external or internal

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75
Q

what is a chalazion

A

chronic inflammation of a meibomian gland that develops spontaneously or may follow a hordeolum

76
Q

what should you do for a persistent lid mass

A

biopsy to rule out malignancy

77
Q

how do you manage a subconjunctival hemorrhage that occurs in the absence of blunt trauma

A

no treatment or evaluation required

this is spontaneous hemorrhage into the potential space between the sclera and the conjunctiva

78
Q

what can cause non traumatic subconjunctival hemorrhage

A

coughing, sneezing, vomiting etc

if recurrent, should investigate an underlying disorder

79
Q

is there a specific treatment for viral conjunctivitis

A

no–> patients should be counselled on precautions to prevent spread

corticosteroids have LIMITED use for treatment of infectious conjunctivitis

80
Q

should you refer for RED EYE plus:

blurred vision

A

yes

81
Q

should you refer for RED EYE plus:

corneal opacification

A

yes

82
Q

should you refer for RED EYE plus:

corneal epithelium disruption

A

yes

83
Q

should you refer for RED EYE plus:

proptosis

A

yes

84
Q

should you refer for RED EYE plus:

discharge

A

no

85
Q

should you refer for RED EYE plus:

pupillary abnormalities

A

yes

86
Q

should you refer for RED EYE plus:

shallow anterior chamber

A

yes

87
Q

should you refer for RED EYE plus:

elevated IOP

A

yes

88
Q

should you refer for RED EYE plus:

pre auricular LN enlargement

A

no

89
Q

should you refer for RED EYE plus:

pre auricular LN enlargement

A

no

90
Q

a patient has an URTI, fever and conjunctivitis… what might they have

A

adenovirus type 3 or 7… pharyngoconjunctival fever

91
Q

what is erythema multiforme and why do we care

A

a serious systemic disorder (or possible allergic response to meds) –> results in severe CONJUNCTIVITIS, irreversible conjunctival scarring and blindness

bulls eye targetoid shaped lesions are found on the skin

92
Q

what do we call erythema multiforme with ocular involvement

A

steven’s johnson syndrome

93
Q

when should you refer presumed bacterial conjunctivitis

A

if do not improve with two days of antibiotic treatment

94
Q

why is ophtho referral done for hyperpurulent conjunctivitis

A

possible gonococcal cause

this is serious and potentially blinding

95
Q

should you prescribe topical anesthetics if prolonged analgesia is required for a red eye

A

NO, NEVER

DONT DO IT

96
Q

why should you not prescribe topical anesthetics if prolonged analgesia is required for a red eye

A

inhibits growth and healing of the corneal epithelium

severe allergic reactions are possible

corneal anesthesia eliminated the protective blink reflex and exposes the cornea to dehydration, injury and infection

97
Q

which ocular diseases are markedly potentiated by topical corticosteroids

A

herpes simplex keratitis and fungal keratitis

98
Q

why should you not use topical corticosteroids for conjunctivitis/red eye (undifferentiated)

A

have only limited effects on conjunctivitis

will potentiate herpes simplex keratitis and fungal keratitis

may mask symptoms of inflammation

PROLONGED USE CAN LEAD TO CATARACT FORMATION

local application for 2-6 weeks can cause increased IOP which can lead to ocular nerve damage

99
Q

why should you not use topical corticosteroids for conjunctivitis/red eye (undifferentiated)

A

have only limited effects on conjunctivitis

will potentiate herpes simplex keratitis and fungal keratitis

may mask symptoms of inflammation

PROLONGED USE CAN LEAD TO CATARACT FORMATION

local application for 2-6 weeks can cause increased IOP which can lead to ocular nerve damage

100
Q

do bony orbit rim fractures usually cause decrease in ocular or visual function

A

no

101
Q

which bones make up the orbital floor

A

maxillary

palatine

zygomatic

102
Q

what is the risk of orbital floor fractures

A

may “blow out” into the maxillary sinus from blunt impact

orbital contents (IR, IO) can become trapped and restrict vertical eye movement and case double vision

can cause decreased sensation of the cheek/teeth on the ipsilateral side

bleeding of the nose may occur acutely after injury

103
Q

if vertical eye movement is restricted, and/or there is decreased sensation on the cheek/teeth, what bony orbit fracture might you suspect

A

orbital floor fracture

104
Q

what happens if you dont recognize and repair a canalicular laceration

A

chronic tearing (epiphora)

tear drainage occurs at the medial aspect of the lids through the lower lacrimal punctum

105
Q

what is the risk associated with the fact that lacerations to the conjunctiva heal quickly?

A

may conceal a penetrating injury to the globe

106
Q

what do you worry about in the setting of blunt trauma to the eyeball

A

may produce iritis–> results in pain, redness, photophobia and a small pupil (miosis)

107
Q

what are the risks of eyeball contusions

A

may deform the pupil by tearing the iris root or by notching the pupillary margin

may result in tearing of the small vessels in the anterior chamber angle and thus hemorrhage of the anterior chamber (HYPHEMA)

108
Q

what is a hyphema and how long does it last

A

tearing of the small vessels in the anterior chamber angle and thus hemorrhage of the anterior chamber

usually resolves in 3-5 days

109
Q

what is the usual result of injury to the lens

A

cataract formation

blunt trauma to the globe can cause partial dislocation (subluxation) of the lens

110
Q

what protects the retina

A

externally–> sclera

internally–> choroid

it is thin and vulnerable tho

111
Q

what does the retina look like when it is edematous

A

white

112
Q

what would be the presentation of traumatic macular damage

A

reduced visual acuity without producing complete blindness

113
Q

of which types of injuries should you always be suspicious

A

metal on metal injuries

should refer for evaluation by ophtho even if vision is normal and eye looks fine

114
Q

does an intraocular foreign body produce pain?

A

NO

lens, retina and vitreous have no nerve endings to conduct pain

115
Q

what should you do if there is traumatic damage to the posterior segment (including retinal detachment or foreign body)

A

refer

116
Q

what should you NOT do if you suspect penetrating injury of the globe

A

you should NOT manipulate the eyelids or perform mobility testing

a penlight is used to inspect the eyes for signs of perforation (reduced depth of the anterior chamber or iris prolapse into the penetrating wound)

DO NOT ORDER MRI IN CASES OF METAL FOREIGN BODIES

117
Q

what are the signs of penetrating injury of the globe

A

reduced depth of the anterior chamber or iris prolapse into the penetrating wound

118
Q

what can you use for pain relief in ocular injury/penetrating injury of the globe

A

ONE drop of proparacaine hydrochloride 0.5%

119
Q

what can you use for pain relief in ocular injury/penetrating injury of the globe

A

ONE drop of proparacaine hydrochloride 0.5%

120
Q

what test should you NOT order in the case of possible metal foreign body

A

MRI

121
Q

what is the true ocular emergency we should know–number one ocular emergency

A

chemical burn of the conjunctiva/cornea

alkali burn usually causes more damage than an acid burn

122
Q

which causes more damage–alkali or acid burn to the eye

A

alkali

this is because penetrates the ocular tissue more rapidly

123
Q

how quickly do you need to initiate therapy in a true ocular emergency like a chemical burn of the eye

A

within minutes

124
Q

how do you manage chemical burns of the eye

A

all require IMMEDIATE and PROFUSE irrigation followed by urgent referral

125
Q

what are the clinical signs of a penetrating/perforating injury

A

irregular pupil shape (TEAR DROP shape)

shallow anterior chamber

uveal prolapse

hyphema

126
Q

what are the clinical signs of a penetrating/perforating injury

A

irregular pupil shape (TEAR DROP shape)

shallow anterior chamber

uveal prolapse

hyphema

127
Q

list the urgent ocular conditions we should know

A

penetrating injury to the globe

conjunctiva/corneal foreign bodies

hyphema

lid laceration

radiant energy burn (welder’s burns or snow blindness)

traumatic optic neuropathy

128
Q

list the semi urgent conditions we should know

A

orbital fracture

subconjunctival hemorrhage in the presence of blunt trauma

129
Q

state whether the following is a true ocular emergency, an urgent situation or a semi urgent condition:

penetrating injury to the globe

A

urgent

130
Q

state whether the following is a true ocular emergency, an urgent situation or a semi urgent condition:

orbital fracture

A

semi-urgent

131
Q

state whether the following is a true ocular emergency, an urgent situation or a semi urgent condition:

chemical burn of the eye

A

true ocular emergency

132
Q

state whether the following is a true ocular emergency, an urgent situation or a semi urgent condition:

traumatic optic neuropathy

A

urgent

133
Q

state whether the following is a true ocular emergency, an urgent situation or a semi urgent condition:

hyphema

A

urgent

134
Q

state whether the following is a true ocular emergency, an urgent situation or a semi urgent condition:

conjunctiva/corneal foreign body

A

urgent

135
Q

state whether the following is a true ocular emergency, an urgent situation or a semi urgent condition:

lid laceration

A

urgent

136
Q

state whether the following is a true ocular emergency, an urgent situation or a semi urgent condition:

subconjunctival hemorrhage in the present of blunt trauma

A

semi urgent

137
Q

state whether the following is a true ocular emergency, an urgent situation or a semi urgent condition:

radiant energy burn

A

urgent

138
Q

how quickly do you have to initiate therapy in urgent ocular situations

A

within hours

139
Q

how quickly do you need to initiate therapy in semi urgent ocular conditions

A

refer patients with semi urgent conditions to ophtho within 1-2 days

140
Q

how do you manage a penetrating injury to the globe

A

place eye shield

prevent patient from eating or drinking

Xray/CT to rule in/out foreign bodies

141
Q

how should you manage a conjunctival/corneal foreign body

A

requires topical anesthesia followed by removal of the object via irrigation or cotton tipped applicator

142
Q

how should you manage a hyphema

A

IMMEDIATE REFERRAL

elevation of intraocular pressure may necessitate medical/surgical intervention

hyphema may be a sign of GLOBE RUPTURE or ocular injury (dislocated lens, retinal detachment)

143
Q

what may hyphema be a sign of

A

globe rupture

dislocated lens

retinal detachment

144
Q

what may hyphema be a sign of

A

globe rupture

dislocated lens

retinal detachment

145
Q

how should you manage a lid laceration

A

can be sutured if not deep and neither the lid margin nor the cannaliculi are involved

refer to ophtho if either of those are involved

146
Q

how should you manage a radiant energy burn (welder’s burn, snow blindness)

A

requires topical anesthesia, examination, topical antibiotic and cycloplegic agent

patching

corneal epithelium regenerates quickly and this dissipates over a few hours

147
Q

how should you manage a traumatic optic neuropathy

A

uncommon but consider this in patients with cranial/ maxillofacial trauma

patients present with history of facial trauma and with UNILATERAL decreased vision and RAPD

may benefit from IV high dose methylprednisone if given within 8 hours after initial injury

148
Q

how might a traumatic optic neuropathy present

A

patients present with history of facial trauma and with UNILATERAL decreased vision and RAPD

149
Q

how should you manage a orbital fracture

A

semi urgent

ice packs

AVOID BLOWING NOSE

PO antibiotics

referral within 1-2 weeks is okay

150
Q

how should you manage a orbital fracture

A

semi urgent

ice packs

AVOID BLOWING NOSE

PO antibiotics

referral within 1-2 weeks is okay

151
Q

list two cycloplegics

A

homatropine hydrobromide 5%

cyclopentolate hydrochloride 1%

152
Q

what do the cycloplegics do

A

used to relax the iris and ciliary body and to relieve pain and discomfort of most forms of non penetrating ocular injuries

longer acting cycloplegics are usually contraindicated

153
Q

name a longer acting cycloplegic (usually contraindicated)

A

atropine

154
Q

which kinds of ocular wounds may benefit from antibiotic ointment

A

one time use in clean wounds

do not use frequently due to risk of allergic reaction or superinfection

155
Q

should you ever prescribe anesthetic eye drops?

A

NO never

they are toxic to the corneal epithelium when used repeatedly

156
Q

define amblyopia

A

form of visual acuity loss NOT correctable by glasses in an otherwise healthy eye

157
Q

what % of the young adult population is affected by amblyopia

A

2%

158
Q

when does amblyopia develop

A

infancy and early childhood

159
Q

how do you detect amblyopia

A

measured by estimating visual acuity

160
Q

what causes amblyopia

A

results from disruption of normal eye development

does NOT cause learning disorders

161
Q

is amblyopia permanent

A

no, it can be cured if caught and treated early

definitely works if started before age 5

rarely successful past age 10

162
Q

what condition is also present in 50% of kids with amblyopia

A

strabismus

163
Q

define strabismus

A

misalignment of the two eyes

usually unilateral tho can be bilateral

164
Q

what is the impact of strabismus

A

the brain favours the “good” eye and ignores the “bad”/lazy eye

165
Q

define strabismus amblyopia

A

the eye habitually used for fixation retains normal acuity and the non-preferred eye develops decreased vision

adult onset usually causes diplopia

even with small angle strabismus the amblyopia can be severe

166
Q

define refractive amblyopia

A

results from a difference in refractive error between the two eyes

the eye with the lesser refractive error provides the clearer image and is favored over the other resulting in amblyopia

children with asymmetric hyperopia are susceptible

can be as severe as strabismus amblyopia

167
Q

define form-deprivation and occlusion amblyopia

A

can result when opacities of the ocular media (cataracts), corneal scarring or ptosis prevent adequate sensory input

amblyopia can persist even when the cause of the media opacity or ptosis is corrected

rarely occurs from patching the normal eye

168
Q

define form-deprivation and occlusion amblyopia

A

can result when opacities of the ocular media (cataracts), corneal scarring or ptosis prevent adequate sensory input

amblyopia can persist even when the cause of the media opacity or ptosis is corrected

rarely occurs from patching the normal eye

169
Q

define strabismus

A

misalignment of the two eyes

170
Q

what do you call strabismus when the degree of misalignment varies with direction of gaze

A

incomitant, paralytic or restrictive

one or more extraocular muscles may be injured or restricted

171
Q

what causes strabismus

A

one or more extraocular muscles may be injured or mechanically restricted

may be due to neuro disorder, orbital disease, trauma, restrictive ophthalmopathy of thyroid disease or blown out fracture

172
Q

how do you test strabismus in kids

A

corneal light reflex

173
Q

define heterophoria

A

latent tendency for misalignment of the eyes that manifests only if binocular vision is disrupted by covering one eye

with binocular vision, the eyes are well aligned but when one eye is covered the “bad” eye will drift to position of rest

minor degree is normal in most individuals

174
Q

how do you detect heterophoria

A

alternating cover/uncover testing–> can still be present in the absence of a tropia (the eye that was just covered will show phoria if it shifts “back”)

175
Q

define heterotropia

A

another term for strabismus–misalignment even without cover/uncover

usually binocular vision is reduced

testing by shift testing

the uncovered eye will show tropia if it shifts

176
Q

define esotropia/esophoria

A

deviating eye is inward towards nose

177
Q

define exotropia/exophoria

A

outward deviating eye alternating with alignment of eyes

178
Q

define hypophoria/hypotropia

A

upward deviation

179
Q

define hyperphoria/hypertropia

A

downward deviation

180
Q

what should you do is you suspect strabismus and/or amblyopia

A

prompt referral to ophtho

181
Q

how do you treat strabismic ambylopia

A

if less than age 5, treat with occlusion of unaffected eye–> treatment better with younger kids but can be effected up to age 18

182
Q

how do you treat refractive ambylopia

A

glasses followed by patching of the better eye if the acuity difference occurs beyond 4-8 weeks

can also be achieved by dilating drops daily to better seeing eye which blurs vision and forces the kid to use amblyopic eye

183
Q

how long do you monitor a kid for recurrence of amblyopia after treatment is stopped

A

3 months

184
Q

how do you treat strabismus

A

most effective way to support fusion is to treat the amblyopia and equalize the vision

glasses can treat some or all of ESOTROPIA and may decrease the frequency of deviation

surgical correction of misalignment may be necessary but it is NOT an alternative to glasses and patching when amblyopia is present

vision training has NO proven value

185
Q

what is leukocornia and should you refer?

A

YES–requires IMMEDIATE referral to ophtho

this may be the presenting sign of an intraocular tumour (a retinoblastoma) or a visually significant cataract

can also have glaucoma from the increased pressure from the tumour

186
Q

what is often the presenting sign of intraocular tumour

A

leukocornia

187
Q

how does glaucoma present in the infant

A

photophobia, tearing, corneal enlargement and clouding

needs immediate referral, ?intraocular tumour/ retinoblastoma

ophtho (5 decks)

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