CK 2 Flashcards
intracranial pressure - normal range / can cause
at rest, is normally 7–15 mmHg for a supine adult.
- enlarged blind spot
blind spot - definition
small portion of the visual field of each eye that corresponds to the position of the optic disk. There are no photoreceptors, and, therefore, there is no image detection in this area
Retinitis - pathophysiology / associated with
retinal edema and necrosis leading to scar
- immunosuppression
Central retinal artery occlusion - clinical presentation and management
acute, PAINLESS monocular vision
management: evaluate for embolic source (carotid artery, atherosclerosis, cardiac vegetations, patent foramen ovale)
Central retinal artery occlusion - fundoscopic exam
retina cloudy with attenuated vessels and cherry red spot at fovea
Retinitis pigmentosa is an / clinical presentation
inherited retinal degeneration
- painless, progressive vision loss beginning with night blindess (robs are affected first)
- tunnel blindness
Retinitis pigmentosa - fundoscopic exam
bone spicule - shaped around macula
Retinal vein occlusion - pathophysiology
thrombosis
Retinal vein occlusion - fundoscopic exam
Retinal hemorrhage and venous engorgement, edema in affected area
retinal detachment - pathophysiology
separation of neurosensory layer (robs and cones) of retina from outermost pigmented epithelium –> degeneration of photoreceptors –> vision loss
retinal detachment - may be secondary to
- retinal breaks
- diabetic traction (scar tissue from neovascularization shrinks, causing the retina to wrinkle and pull from its normal position)
- inflammatory effusions
retinal breaks are more common in
- patients with myopia
2. history of head trauma
retinal breaks - management
surgical emergency
retinal breaks are often preceded by
- posterior vitreous detachment (FLASHES AND FLOATERS) –> small moving spots that appear in your field of vision.
- eventual monocular loss of vision like a curtain drawn and down
diabetic retinopathy - types
- nonproliferative
2. proliferative
nonproliferative diabetic retinopathy (mechanism)
damaged capillaries leak blood –> lipids and fluids seep into retina –> hemorrhage and macular edema
nonproliferative diabetic retinopathy - treatment
- blood sugar control
2. macular laser
proliferative diabetic retinopathy (mechanism)
chronic hypoxia results in new blood vessels formation with resultant traction on retina
treatment of proliferative diabetic retinopathy
- anti - VEGF (bevacizumab)
- peripheral retinal photocoagulation
- surgery
peripheral retinal photocoagulation - mechanims
uses light to coagulate tissue (energy from a strong light source is absorbed by tissue and is converted into thermal energy)
generally - diabetic retinopathy findings
- hemmorrhage
- exudates
- microanurysms
- vessel proliferation
Age-related macular degeneration
degeneration of macula
Age-related macular degeneration causes (symptoms)
distortion (metamorphopsia) and eventual loss of central vision
metamorphopsia
defective vision, with distortion of the shape of objects seen
Age-related macular degeneration - types and frequency
- Dry (nonexudative) - >80%
2. Wet (exudative) - 10-15%
Dry (nonexudative) Age-related macular degeneration (mechanims)
deposition of yellowish extracellular material in and between Bruch membrane and retinal pigment epithelium (drusen) with GRADUAL decreasing in vision
Drusen are (and composed by)
- deposition of yellowish extracellular material in and beneath Bruch membrane and retinal pigment epithelium - composed by lipids, immune and inflammatory related proteins, amyloid associated
prevent progression of Dry (nonexudative) Age-related macular degeneration with
- multivitamin supplements
2. antioxidant supplements
Wet (exudative) Age-related macular degeneration (mechanims)
RAPID loss of vision due to bleeding 2ry to choroidal neovasvularization
treat Wet (exudative) Age-related macular degeneration (mechanims) with
- anti-VEGF (RANIBIZUMAB)
2. Laser
wet vs dry Age-related macular degeneration (according frequency and time of visual loss)
- Dry (nonexudative) - >80% - gradual
2. Wet (exudative) - 10-15% - rapid
Central retinal artery occlusion - type of pain
painless
Central retinal artery occlusion - management
evaluate for embolic source (carotid artery, atherosclerosis, cardiac vegetations, patent foramen ovale
Retinal detachment - fundoscopy
crinkling of retinal tissue and changes in vessels direction
retinal artery occlusion - treatment
- 100% O2
- ocular massage
- acetazolamide
- anterior chamber paracentiesis (decreased IOP)
- thrombolytics
- evaluate embolic source
retinal vein occlusion - treatment
intravitreal injection of ranibizumab (VEGF-A inh)
Reattachemen of retina is attempted …
with a number of mechanical methods such as:
- surgery 2. laser 3. cryotherapy
- injection of an expansile gas that pushes the retina back up against the globe of the eye
The MCC of blindness in older person in the US
DM
diabetic retinopathy - how to prevent / most accurate test
- annual screening (before serious visual loss)
- flurescein angiography
diabetic retinopathy - surgery
vitrectomy (remove the vitreous gel from the middle of the eye): to remove vitreal hemorrhage obstructing
neovascular or wet Macular degeneration - results of the treatment
- over 90% of patients will expereience a halt (stop) of progression
- 1/3 will have improvement in vision
neovascular or wet Macular degeneration - treatment
best initial: VEGF inh (ranibizumab, bevasizumab, aflibercept. Injected directly into the vitreous chamber every 4-8 wks.
….. is the most common predisposing factor for orbital cellulitis (other RFs)
Bacterial sinusitis
other RF: dental infection, trauma, skin infection
orbital cellulitis diagnosis and treatment
diagnosis: clinically, CT if necessary
treatment: IV antibiotics, surgical drainage of abscess
orbital cellulitis - symptoms
Painful eye movements Ophthalmoplegia Proptosis Visual changes
Contact lens-associated infectious keratitis
- medical emergency / painful, red eye and opacification and ulceration of the cornea
- Most cases are due to Gram-negative organisms but can also be due to Gram-positive organisms as well as certain fungi and amoebas.
- Most cases require topical broad-spectrum antibiotics.
Dacryocystitis presents with….. / causes
- inflammatory changes in the MEDIAL canthal region of the eye.
- S. aureus + beta-hemolytic Strep
- SYSTEMIC ANTIBIOTICS
Chalazion presents as
lid discomfort. It is a chronic, granulomatous inflammation of the meibomian gland. It appears as a hard, painless lid nodule.
Hordeolum refers to .. (+ treatment)
abscess located over the upper or lower eyelid. It is usually caused by Staphylococcus aureus. It appears as a localized red, tender swelling over the eyelid.
initial treatment includes warm compresses –> if persists for 1-2 weeks –> incision
Formal visual acuity testing for children is recommended starting
at age 4 as well as in cooperative 3-year-olds
Snellen chart is the gold standard
viral ophalmopathy in HIV (+)
- HSV or VZV: severe, acute retinal necrosis associated with PAIN, keratitis, uveitis, and funduscopic findings of peripheral pale lesions and central retinal necrosis.
- , CMV retinitis is PAINLESS, not usually associated with keratitis or conjunctivitis, and characterized by funduscopic findings of hemorrhages and fluffy or granular lesions around the retinal vessels.
special characteristic of allergic conjuctivitis
ocular pruritus, eyelid edema and tearing
catarract symptoms / examination
painless blurred vision, glare, and often halos around lights.
in early cataract formation may show a normal red reflex and retinal visualization, but as the cataract progresses, the red reflex is lost and retinal detail may not be visible.
Ophthalmoscopic examination of retinal detachment reveals
a grey, elevated retina.
Postoperative endophthalmitis
- the MC form of endophthalmitis.
- within six weeks of surgery
- pain and decreased visual acuity
- swollen eyelids and conjunctiva, hypopyon, corneal edema and infection.
- vitreous can be sent for Gram stain and culture.
- Based on the severity, intravitreal antibiotic injection or vitrectomy is done.
closed angle glaucoma - gold standard for diagnosis
gonioscopy
Vitreous hemorrhage
- sudden loss of vision and onset of floaters.
MCC: diabetic retinopathy. - important diagnostic clue: fundus is hard to visualize, and even if it is visualized, details may be obscured.
- immediate ophthalmologic consultation
- For patients with underlying medical conditions, conservative treatment (i.e., upright position during sleep, which enhances settling of the hemorrhage) is recommended.
Strabismus after age 4 months
requires treatment to prevent amblyopia and diplopia. Asymmetric corneal light reflections and deviation on cover test are concerning findings. The standard treatment is occlusion (patching) or penalization (blurring) of the normal eye.
NOTHING IN FIRST 4 MONTHS
Spontaneous subconjunctival hemorrhage - management
is a benign finding, and does not require any treatment
coagulation studies if under anticoagulant drugs
Episcleritis
acute redness and tearing with injection of conjunctival and episcleral vessels. Patients may have mild irritation, but overt pain and diminished visual acuity, as seen in this patient, are not consistent with episcleritis.
clinical signs of retioblastoma
Leukocoria (white pupillary reflex) –> immediate referral to an ophthalmologist to evaluate for Rb.
Other presenting signs include strabismus + nystagmus.
Sympathetic ophthalmia
damage of one eye (the sympathetic eye) after a penetrating injury to the other eye
- immunologic mechanism involving the recognition of ‘hidden’ antigens.
- anterior uveitis, but panuveitis, papillary edema, and blindness may develop
Circulated immune complexes can affect the eye in …(disease)
SLE
viral conjuctivitis treatment
warm or cold compresses +/- anthihistamines decongestants drops
allergic conguctivities
over the counter antihistamines decongestants drops for intermittent symptoms
mast cells stabilizer/antihistamine drops for frequent episodes
neonatal conjuctivitis - types and age of onset
chemical: day 1: eye lubricant
gonococcal: day 2-5: single IM dose of 3rd gener ceph
chlamydial: 5-14: macrolide PO –> monitor for pyloric stenosis
neonatal conjuctivitis - chemical - findings
mild conjunctival irritation + tearing after silfer nitrate ophthalmic prophylaxis
neonatal conjuctivitis - gonococcal - findings
- marked eyelid swelling
- profuse purulent discharge
- corneal edema/ulceraction
neonatal conjuctivitis - chlamydial - findings
- mild eyelid swelling
- watery, serosanguinous or mucopurulent eye discharge
viral vs bacterial vs allergic conjuctivitis - dicharge reappearing after wiping
only bacterial
viral vs bacterial vs allergic conjuctivitis - appearance
viral: diffuse injection: follicular or bumpy
bacterial: diffuse infection: nonfollicular
allergic: diffuse injection, follicular or bumby, conjuctival edema (chemosis)
nasolacrimal duct obstruction (dacryostenosis) - presentation /
- unilateral tearing and minimal conjunctival injection in infants
- Massaging the nasolacrimal ducts is the most appropriate treatment
topical erythromycin is effective
aganist n. gonorr (but not clamydia)
viral vs bacterial vs allergic conjuctivitis - duration
viral 1-2 wks
bacterial: 1-2 wks
allergic: less than 30 mins - forever
Choroidal rupture
- occurs due to blunt ocular trauma.
- scotomas, retinal edema, hemorrhagic detachment of macula, subretinal hemorhage, crescent-shaped steak concentric of the optic nerve
- blurred vision following blunt trauma
corneal ulceration - presentation
- presents as a foreign body sensation, blurred vision, photophobia, and pain
- history of contact lens use, recent trauma, or ocular disease
- erythematous, and ciliary injection, Purulent exudates
HSV retinitis may be characterized
by rapidly progressing bilateral necrotizing retinitis (referred to as the “acute retinal necrosis syndrome”)
Red reflex testing is performed in children to detect
congenital cataract or retinoblastoma
in strabismus the red reflex is more intense in the deviated eye
corneal light reflex testing assesses
ocular alignment (strabismus)
dental carries - orbital cellulitis
Dental caries or abscesses, particularly in maxillary teeth (which are close to the sinuses and orbits), can predispose to orbital cellulitis.
C. trachomatis - diagnosis / treatment
- The diagnosis can be made clinically by examination of the tarsal conjunctivae. C trachomatis may be visible by Giemsa stain examination of conjunctival scrapings
- Oral azithromycin for the entire region
- eyelid surgery to preserve vision
Herpes zoster ophthalmicus
dendriform corneal ulcers and a vesicular rash in the trigeminal distribution. (VS HSV keratitis: no systemic symptoms and rash)
Treatment started within 72 hrs after eruption with high dose acyclovir reduces the development of complications.
other condition associated with leukocoria (beside Rb)
- uveitis (pain)
2. cataract (bilateral)
Rb - how to confirm diagnosis
MRI of ortbit and brain
HIV retinopathy
cotton-wool retinal lesions that are rarely hemorrhagic and tend to resolve over weeks to months.
- does not commonly cause floaters or blurred vision.
trachoma in eye
acute trachoma: folicular conjunctivitis and inflamation
repeated or chronic infection: inversion of the eyelashes and scarring of the cornea
orbital cellulitis vs preseptal cellulitis
preseptal is infection of the anterior to the orbital septum and does not present with proptosis, visual changes or opthalmoplegia
uveitis vs acute glaucoma regrading pupil
glaucoma: dilated and nonreactive to light
uveitis: constricted with a poor light response
atopic keratoconjuctivitis
severe form of ocular allergy, MC symptoms are itching, tearing, thick mucus discharge, photophobia, blurred vision, different from allergic conjunctivitis by more sever symptoms, more prolonged, potential visual impairment due to corneal involvement, thickening of the eyelid and surrounding skin
herpes simplex keratitis is caracterized by
corneal vesicels and dendritic ulcers
CMV vs HIV retinopathy
HIV: cotton wool retinal lesions that are rarely hemorrhagic and tend to resolve over weeks to months, DOES NOT CAUSE FLOATERS OR BLURRED VISION
the best way to prevent both C. trachomatis and gonococcal conjunctivitis
sit is to screen for and treat these infections in pregnant women younger than 25 or with RFs
strabismus - treatment options
- penalization therapy: cycloplegic drops to blur normal eye
- occlusion therapy: patch normal eye
- prescription eyeglasss
- surgery
strabismus reflexes
- more intense red
2. abnormal light
MCC of corneal blindness in USA
HSV
acute glaucoma - 1st line treamtne
mannitol IV
retinopathy of prematurity
retinal detachment can cause leukoria (born berfore 30 wks)
RB - biopsy
NEVER
bacterial conjunctivitis - treatment
- erythromycin ointment
- polymyxin-trimethoprim drops
- azithromycin drops
- prederred agent in contact lens wearers: fluoroquinolone drops
thrombolytics in retinal artery occlussion
in 4-6 hours
- INTRAARTERIALLY
