CM: Chronic Vision Loss & Trauma

Question 1

Which red eye conditions are vision threatening?

Answer 1

corneal infections (keratitis)
scleritis
hyphema
iritis
acute glaucoma
orbital cellulitis
chemical injury (alkali urgent, acid next day)
should all be recognized and referred to opthalmologist

Question 2

diffuse, erythematous swelling of lids

lids tender to touch, may be swollen shut

Answer 2

cellulitis

Question 3

What is the difference b/w pre-septal/pre-orbital and orbital cellulitis?

Answer 3

pre-septal/pre-orbital - visual acuity, pupils, motility normal, no proptosis
orbital - opposite, motility may be painful, APD

Question 4

When should conjunctivitis be referred?

Answer 4

vision impaired, inf suspected, pt fails to respond to Rx after 3-4 days

Question 5

Conjuncitivitis discharge:
purulent
clear
stringy, white mucus
What caused it?

Answer 5

bacteria
virus (look for preauricular lymphadenopathy)
allergies

Question 6

When should neonatal conjunctivitis consult an opthalmologist?

Answer 6

if pseudomonas suspected - can damage cornea

gonococcal conjunctivitis needs urgent treatment

Question 7

mild, mucopurulent conjunctivitis in a neonate

often accompanied by pneumonitis and otitis media

Answer 7

chlamydia

Question 8

dry eyes, redness, burning, foreign body sensation, reflex tearing, lack of luster

Answer 8

keratoconjunctivitis sicca

Question 9

pain, photophobia, blurred vision

Answer 9

corneal disorder symptoms

Question 10

When is a fluorescein exam appropriate?

Answer 10

aids in detection of irregularities of corneal surface - when abrasion suspected

Question 11

redness, tearing, foreign body sensation, blurred vision, photophobia

Answer 11

corneal abrasion

Question 12

discrete corneal opacity (infiltrate) on exam

Answer 12

bacterial keratitis - don’t use steroids!

Question 13

blood in anterior chamber from blunt trauma, red eye, decreased vision, pain, hx of blunt trauma

Answer 13

hyphema

Question 14

circumcorneal redness, pain, photophobia, decreased vision, miotic pupil

Answer 14

iritis - cataract and glaucoma can be complications

Question 15

severe ocular pain, frontal headache, N/V, blurred vision with halos around lights
eye usually red, pupil mid dilated and oval, cornea cloudy

Answer 15

acute glaucoma

Question 16

What are risk factors for macular degeneration?

Answer 16

advanced age
fair skin
family hx of ARMD
smoking and CV dz

Question 17

What can minimize effects of ARMD?

Answer 17

stop smoking, control CV dz, diet high in fruits and vegetables lowers risk, antioxidants, anti-VEGF

Question 18

What are the risk factors for glaucoma?

Answer 18

elevated IOP
African or Hispanic heritage
advanced age
family hx
HTN, diabetes, myopia

Question 19

How is glaucoma managed?

Answer 19

meds: beta blockers, adrenergic agonists, cholinergic agonists, prostaglandin analogs, carbonic anhydrase inhibitors
surgery: laser or filtration, cyclodestructive of ciliary body, insert drainage device

Question 20

When is surgery for cataracts indicated?

Answer 20

significant visual impairment, daily activities curtailed

no current medical Rx

Question 21

What is the epidemiology of ocular trauma?

Answer 21

accounts for 40% of all monocular blindness
80% are male, avg age = 30
lower socioeconomic status more likely
occupational injuries most common, domestic increasing
blunt objects are leading cause
motor vehicle accidents and sports related increasing

Question 22

What do the following terms regarding ocular trauma mean?

a. eyewall
b. closed globe injury
c. open globe injury
d. rupture
e. laceration
f. perforating injury
g. penetrating injury
h. intraocular foreign body
i. contusion
j. lamellar laceration

Answer 22

a. sclera and cornea
b. eyewall does not have full thickness wound
c. eyewall has full thickness wound
d. full thickness wound of eye wall caused by blunt object
e. full thickness wound of eye wall caused by sharp object
f. 2 full thickness: entrance and exit - of eyewall, usually sharp object or missile
g. 1 full thickness laceration of eyewall, usually sharp object
h. causes entrance laceration
i. closed globe injury from blunt object
j. closed globe injury usually from sharp object

Question 23

redness concentrated to palpebral area

Answer 23

conjunctivitis

Question 24

conjunctivitis with copious purulent discharge

Answer 24

suspect n. gonorrhoeae

Question 25

mild conjunctival reaction and lid swelling but no significant discharge in neonate

Answer 25

chemical conjunctivitis (from silver nitrate)

Question 26

swollen lids, purulent exudate, beefy red conjunctiva, conjunctival edema in infant

Answer 26

neonatal gonococcal conjunctivitis - refer to ophthalmologist

Question 27

What are episcleritis and scleritis?

Answer 27

inflammatory redness and tenderness
episcleritis - minimal pain and superficial vessels over cornea involved
scleritis - more dangerous - moderate to severe pain and red eye (with purplish hue), typically signs of systemic dz

Question 28

optic disc cupping

Answer 28

open angle glaucoma

Question 29

What is a cataract?

Answer 29

opacity in crystalline lens of eye