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Ophthalmology -FA > CK 2 > Flashcards

CK 2 Flashcards

1
Q

intracranial pressure - normal range / can cause

A

at rest, is normally 7–15 mmHg for a supine adult.

- enlarged blind spot

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2
Q

blind spot - definition

A

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

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3
Q

Retinitis - pathophysiology / associated with

A

retinal edema and necrosis leading to scar

- immunosuppression

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4
Q

Central retinal artery occlusion - clinical presentation and management

A

acute, PAINLESS monocular vision

management: evaluate for embolic source (carotid artery, atherosclerosis, cardiac vegetations, patent foramen ovale)

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5
Q

Central retinal artery occlusion - fundoscopic exam

A

retina cloudy with attenuated vessels and cherry red spot at fovea

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6
Q

Retinitis pigmentosa is an / clinical presentation

A

inherited retinal degeneration

  1. painless, progressive vision loss beginning with night blindess (robs are affected first)
  2. tunnel blindness
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7
Q

Retinitis pigmentosa - fundoscopic exam

A

bone spicule - shaped around macula

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8
Q

Retinal vein occlusion - pathophysiology

A

thrombosis

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9
Q

Retinal vein occlusion - fundoscopic exam

A

Retinal hemorrhage and venous engorgement, edema in affected area

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10
Q

retinal detachment - pathophysiology

A

separation of neurosensory layer (robs and cones) of retina from outermost pigmented epithelium –> degeneration of photoreceptors –> vision loss

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11
Q

retinal detachment - may be secondary to

A
  1. retinal breaks
  2. diabetic traction (scar tissue from neovascularization shrinks, causing the retina to wrinkle and pull from its normal position)
  3. inflammatory effusions
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12
Q

retinal breaks are more common in

A
  1. patients with myopia

2. history of head trauma

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13
Q

retinal breaks - management

A

surgical emergency

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14
Q

retinal breaks are often preceded by

A
  1. posterior vitreous detachment (FLASHES AND FLOATERS) –> small moving spots that appear in your field of vision.
  2. eventual monocular loss of vision like a curtain drawn and down
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15
Q

diabetic retinopathy - types

A
  1. nonproliferative

2. proliferative

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16
Q

nonproliferative diabetic retinopathy (mechanism)

A

damaged capillaries leak blood –> lipids and fluids seep into retina –> hemorrhage and macular edema

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17
Q

nonproliferative diabetic retinopathy - treatment

A
  1. blood sugar control

2. macular laser

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18
Q

proliferative diabetic retinopathy (mechanism)

A

chronic hypoxia results in new blood vessels formation with resultant traction on retina

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19
Q

treatment of proliferative diabetic retinopathy

A
  1. anti - VEGF (bevacizumab)
  2. peripheral retinal photocoagulation
  3. surgery
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20
Q

peripheral retinal photocoagulation - mechanims

A

uses light to coagulate tissue (energy from a strong light source is absorbed by tissue and is converted into thermal energy)

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21
Q

generally - diabetic retinopathy findings

A
  1. hemmorrhage
  2. exudates
  3. microanurysms
  4. vessel proliferation
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22
Q

Age-related macular degeneration

A

degeneration of macula

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23
Q

Age-related macular degeneration causes (symptoms)

A

distortion (metamorphopsia) and eventual loss of central vision

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24
Q

metamorphopsia

A

defective vision, with distortion of the shape of objects seen

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25
Q

Age-related macular degeneration - types and frequency

A
  1. Dry (nonexudative) - >80%

2. Wet (exudative) - 10-15%

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26
Q

Dry (nonexudative) Age-related macular degeneration (mechanims)

A

deposition of yellowish extracellular material in and between Bruch membrane and retinal pigment epithelium (drusen) with GRADUAL decreasing in vision

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27
Q

Drusen are (and composed by)

A
  • deposition of yellowish extracellular material in and beneath Bruch membrane and retinal pigment epithelium - composed by lipids, immune and inflammatory related proteins, amyloid associated
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28
Q

prevent progression of Dry (nonexudative) Age-related macular degeneration with

A
  1. multivitamin supplements

2. antioxidant supplements

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29
Q

Wet (exudative) Age-related macular degeneration (mechanims)

A

RAPID loss of vision due to bleeding 2ry to choroidal neovasvularization

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30
Q

treat Wet (exudative) Age-related macular degeneration (mechanims) with

A
  1. anti-VEGF (RANIBIZUMAB)

2. Laser

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31
Q

wet vs dry Age-related macular degeneration (according frequency and time of visual loss)

A
  1. Dry (nonexudative) - >80% - gradual

2. Wet (exudative) - 10-15% - rapid

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32
Q

Central retinal artery occlusion - type of pain

A

painless

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33
Q

Central retinal artery occlusion - management

A

evaluate for embolic source (carotid artery, atherosclerosis, cardiac vegetations, patent foramen ovale

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34
Q

Retinal detachment - fundoscopy

A

crinkling of retinal tissue and changes in vessels direction

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35
Q

retinal artery occlusion - treatment

A
  1. 100% O2
  2. ocular massage
  3. acetazolamide
  4. anterior chamber paracentiesis (decreased IOP)
  5. thrombolytics
  6. evaluate embolic source
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36
Q

retinal vein occlusion - treatment

A

intravitreal injection of ranibizumab (VEGF-A inh)

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37
Q

Reattachemen of retina is attempted …

A

with a number of mechanical methods such as:

  1. surgery 2. laser 3. cryotherapy
  2. injection of an expansile gas that pushes the retina back up against the globe of the eye
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38
Q

The MCC of blindness in older person in the US

A

DM

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39
Q

diabetic retinopathy - how to prevent / most accurate test

A
  • annual screening (before serious visual loss)

- flurescein angiography

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40
Q

diabetic retinopathy - surgery

A

vitrectomy (remove the vitreous gel from the middle of the eye): to remove vitreal hemorrhage obstructing

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41
Q

neovascular or wet Macular degeneration - results of the treatment

A
  1. over 90% of patients will expereience a halt (stop) of progression
  2. 1/3 will have improvement in vision
42
Q

neovascular or wet Macular degeneration - treatment

A

best initial: VEGF inh (ranibizumab, bevasizumab, aflibercept. Injected directly into the vitreous chamber every 4-8 wks.

43
Q

….. is the most common predisposing factor for orbital cellulitis (other RFs)

A

Bacterial sinusitis

other RF: dental infection, trauma, skin infection

44
Q

orbital cellulitis diagnosis and treatment

A

diagnosis: clinically, CT if necessary
treatment: IV antibiotics, surgical drainage of abscess

45
Q

orbital cellulitis - symptoms

A

Painful eye movements Ophthalmoplegia Proptosis Visual changes

46
Q

Contact lens-associated infectious keratitis

A
  • 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.
47
Q

Dacryocystitis presents with….. / causes

A
  • inflammatory changes in the MEDIAL canthal region of the eye.
  • S. aureus + beta-hemolytic Strep
  • SYSTEMIC ANTIBIOTICS
48
Q

Chalazion presents as

A

lid discomfort. It is a chronic, granulomatous inflammation of the meibomian gland. It appears as a hard, painless lid nodule.

49
Q

Hordeolum refers to .. (+ treatment)

A

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

50
Q

Formal visual acuity testing for children is recommended starting

A

at age 4 as well as in cooperative 3-year-olds

Snellen chart is the gold standard

51
Q

viral ophalmopathy in HIV (+)

A
  • 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.
52
Q

special characteristic of allergic conjuctivitis

A

ocular pruritus, eyelid edema and tearing

53
Q

catarract symptoms / examination

A

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.

54
Q

Ophthalmoscopic examination of retinal detachment reveals

A

a grey, elevated retina.

55
Q

Postoperative endophthalmitis

A
  • 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.
56
Q

closed angle glaucoma - gold standard for diagnosis

A

gonioscopy

57
Q

Vitreous hemorrhage

A
  • 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.
58
Q

Strabismus after age 4 months

A

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

59
Q

Spontaneous subconjunctival hemorrhage - management

A

is a benign finding, and does not require any treatment

coagulation studies if under anticoagulant drugs

60
Q

Episcleritis

A

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.

61
Q

clinical signs of retioblastoma

A

Leukocoria (white pupillary reflex) –> immediate referral to an ophthalmologist to evaluate for Rb.
Other presenting signs include strabismus + nystagmus.

62
Q

Sympathetic ophthalmia

A

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
63
Q

Circulated immune complexes can affect the eye in …(disease)

A

SLE

64
Q

viral conjuctivitis treatment

A

warm or cold compresses +/- anthihistamines decongestants drops

65
Q

allergic conguctivities

A

over the counter antihistamines decongestants drops for intermittent symptoms
mast cells stabilizer/antihistamine drops for frequent episodes

66
Q

neonatal conjuctivitis - types and age of onset

A

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

67
Q

neonatal conjuctivitis - chemical - findings

A

mild conjunctival irritation + tearing after silfer nitrate ophthalmic prophylaxis

68
Q

neonatal conjuctivitis - gonococcal - findings

A
  • marked eyelid swelling
  • profuse purulent discharge
  • corneal edema/ulceraction
69
Q

neonatal conjuctivitis - chlamydial - findings

A
  • mild eyelid swelling

- watery, serosanguinous or mucopurulent eye discharge

70
Q

viral vs bacterial vs allergic conjuctivitis - dicharge reappearing after wiping

A

only bacterial

71
Q

viral vs bacterial vs allergic conjuctivitis - appearance

A

viral: diffuse injection: follicular or bumpy
bacterial: diffuse infection: nonfollicular
allergic: diffuse injection, follicular or bumby, conjuctival edema (chemosis)

72
Q

nasolacrimal duct obstruction (dacryostenosis) - presentation /

A
  • unilateral tearing and minimal conjunctival injection in infants
  • Massaging the nasolacrimal ducts is the most appropriate treatment
73
Q

topical erythromycin is effective

A

aganist n. gonorr (but not clamydia)

74
Q

viral vs bacterial vs allergic conjuctivitis - duration

A

viral 1-2 wks

bacterial: 1-2 wks
allergic: less than 30 mins - forever

75
Q

Choroidal rupture

A
  • 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
76
Q

corneal ulceration - presentation

A
  • 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
77
Q

HSV retinitis may be characterized

A

by rapidly progressing bilateral necrotizing retinitis (referred to as the “acute retinal necrosis syndrome”)

78
Q

Red reflex testing is performed in children to detect

A

congenital cataract or retinoblastoma

in strabismus the red reflex is more intense in the deviated eye

79
Q

corneal light reflex testing assesses

A

ocular alignment (strabismus)

80
Q

dental carries - orbital cellulitis

A

Dental caries or abscesses, particularly in maxillary teeth (which are close to the sinuses and orbits), can predispose to orbital cellulitis.

81
Q

C. trachomatis - diagnosis / treatment

A
  • 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
82
Q

Herpes zoster ophthalmicus

A

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.

83
Q

other condition associated with leukocoria (beside Rb)

A
  1. uveitis (pain)

2. cataract (bilateral)

84
Q

Rb - how to confirm diagnosis

A

MRI of ortbit and brain

85
Q

HIV retinopathy

A

cotton-wool retinal lesions that are rarely hemorrhagic and tend to resolve over weeks to months.
- does not commonly cause floaters or blurred vision.

86
Q

trachoma in eye

A

acute trachoma: folicular conjunctivitis and inflamation

repeated or chronic infection: inversion of the eyelashes and scarring of the cornea

87
Q

orbital cellulitis vs preseptal cellulitis

A

preseptal is infection of the anterior to the orbital septum and does not present with proptosis, visual changes or opthalmoplegia

88
Q

uveitis vs acute glaucoma regrading pupil

A

glaucoma: dilated and nonreactive to light
uveitis: constricted with a poor light response

89
Q

atopic keratoconjuctivitis

A

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

90
Q

herpes simplex keratitis is caracterized by

A

corneal vesicels and dendritic ulcers

91
Q

CMV vs HIV retinopathy

A

HIV: cotton wool retinal lesions that are rarely hemorrhagic and tend to resolve over weeks to months, DOES NOT CAUSE FLOATERS OR BLURRED VISION

92
Q

the best way to prevent both C. trachomatis and gonococcal conjunctivitis

A

sit is to screen for and treat these infections in pregnant women younger than 25 or with RFs

93
Q

strabismus - treatment options

A
  1. penalization therapy: cycloplegic drops to blur normal eye
  2. occlusion therapy: patch normal eye
  3. prescription eyeglasss
  4. surgery
94
Q

strabismus reflexes

A
  1. more intense red

2. abnormal light

95
Q

MCC of corneal blindness in USA

A

HSV

96
Q

acute glaucoma - 1st line treamtne

A

mannitol IV

97
Q

retinopathy of prematurity

A

retinal detachment can cause leukoria (born berfore 30 wks)

98
Q

RB - biopsy

A

NEVER

99
Q

bacterial conjunctivitis - treatment

A
  1. erythromycin ointment
  2. polymyxin-trimethoprim drops
  3. azithromycin drops
  4. prederred agent in contact lens wearers: fluoroquinolone drops
100
Q

thrombolytics in retinal artery occlussion

A

in 4-6 hours

- INTRAARTERIALLY

Ophthalmology -FA (9 decks)

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