Clinical questions - Ophthalmology

Question 1

Presbyopia

Answer 1

lens less elastic with age -> lose ability to focus on near objects

Tx: readers

Question 2

Bacterial conjunctivitis

Answer 2

MC Staph
Unilateral, thick purulent discharge (white, yellow, or green)

Tx:
Topical abx
-Erythromycin
-TMP - polymyxin B

If has genital GC + conjunctivitis - get Ophtho consult

Question 3

Viral conjunctivitis

Answer 3

MC adenovirus
U/L -> B/L
watery, mucoid discharge with gritty sensation
Fever, sore throat, adenopathy

Tx: self limited

Question 4

Allergic conjunctivitis

Answer 4

B/L, watery, itchy

Topical antihistamines, artificial tears

Question 5

Corneal abrasion

Answer 5

severe eye pain, FB sensation
Dx with fluorescein exam

Mgmt:

• topical abx 3-5 days (erythromycin oint)
• PO/Topical analgesics

NO topical anesthetics or steroids

Question 6

Orbital cellulitis

Answer 6

eyelid edema, erythema, pain
eye painful with movement
ophthalmoplegia - weakness or paralysis of EOM
Proptosis - anterior displacement of eye

CT orbits/sinuses

Tx: IV broad sp abx

Risk of vision loss

Question 7

Pre-septal/periorbital cellulitis

Answer 7

eyelid edema, erythema, pain

no pain with movement of eye

Question 8

Open angle glaucoma

Answer 8

Over time
Progressive vision loss, peripheral to central
Tunnel vision

Dx:
Increased IOP on tonometry
Visual field testing
Cupping of optic disc on funduscopic exam

Tx:
Topicals:
Iatanoprost, bimatoprost, timolol
Laser trabeculoplasty
surgery

Question 9

Closed-angle glaucoma

Answer 9

Acute/sudden
Severe eye pain, sudden onset, unilateral
HA, N/V
Blurred vision, halos
conjunctival redness
poorly reactive pupil - mid dilated

Dx: gonioscopy

Tx:
Topical: timolol, apraclonidine, pilocarpine
IV acetazolamide, mannitol
Laser peripheral iridotomy

Question 10

Optic neuritis

Answer 10

demyelination of optic n.
Strong association with MS, females 20-40yo
monocular vision loss, loss of color vision
pain worse with movement

PE: afferent pupillary defect - both dilate - marcus gunn pupil
-swinging eye test - constrict, dilate

Dx: MRI brain w/ contrast and orbits

Tx: IV methylpred - vision recover and delay onset of MS

Question 11

Age related macular degeneration

Answer 11

progressive loss of central vision
Dry type:
-drusen - yellow macular spots
-slow gradual course
Wet type:
-new blood vessels
-severe, rapid vision loss

Slow disease:
Stop smoking - reduce risk and progression
AREDS 2 daily supplement: vit C/E, zinc, copper, lutine, zeaxanthin

Question 12

Prevention of vision loss due to diabetic retinopathy

Answer 12

glycemic control, goal A1c less than 7
BP control keep below 140/90
Annual dilated fundoycopic exam
-T1DM 3-5 y after diagnosis
-T2 at dx
If positive finding on eye exam -> laser photocoagulation to prevent progression/vision loss

Question 13

Retinal detachement

Answer 13

"curtain coming down"
Painless vision loss
floaters
flashes of light -photopsias
peripheral vision loss that expands

Mgmt:
Immediate referral to ophtho
-dilated eye exam with attempt of retina reattachment
can lead to permanent vision loss

Question 14

young woman with painful vision loss in one eye, relative afferent pupillary defect on exam

Answer 14

optic neuritis

Question 15

Elderly woman with HA, jaw claudication, elevated ESR

Answer 15

temporal arteritis/Giant Cell

Question 16

Acute, painless vision loss in one eye, cherry-red spot in macula on funduscopic exam

Answer 16

central retinal a. occlusion

Question 17

Vision loss preceded by floaters and flashes of light

Answer 17

retinal detachement

Question 18

Progressive vision loss starting in periphery, cupping of optic disc on funduscopic exam

Answer 18

open angle glaucoma

Question 19

sudden onset of painful red eye with headache, N/V, blurred vision

Answer 19

acute closed angle glaucoma

Question 20

gradually vision loss due to pacification of the lens

Answer 20

cataracts