CM: EOM Dysfxn & Systemic Dz

Question 1

What is amblyopia?

Answer 1

lazy eye

Question 2

What are the three main causes of amblyopia?

Answer 2

refractive: if one eye has sharper vision than other, child may suppress poorer eye
strabismic: if child sees double due to misalignment, one eye may get suppressed
occlusion: if child cannot see out of one eye due to opacity of ocular media, visual inputs from that eye may not develop

Question 3

What is the treatment of amblyopia?

Answer 3

refractive: glasses, persist after 4-8 wks –> patch
strabismic: surgical realignment of eyes and patch, maybe glasses for refractive component
remove opacities of ocular media
better if treated before 10 yrs old

Question 4

What is the rule of a CN III palsy?

Answer 4

isolated CN III palsy that spares pupil is usually caused by infarct - but there are exceptions

Question 5

What are the characteristics of the eye in CN III palsy?

Answer 5

down and out, ptosis, fixed and dilated pupil

Question 6

What is the eye position in CN VI palsy?

Answer 6

esotropia - pointed inward

Question 7

What is the eye position in CN IV palsy?

Answer 7

up and out –> vertical diplopia

pt may have head tilt away to even it out

Question 8

What are the ocular manifestations seen in diabetes?

Answer 8

nonproliferative: microaneurysm, dot and blot hemorrhages, hard exudates, macular edema, retinal thickening may cause blurred vision
proliferative: retinal ischemia, cotton wool spots, neovascularization –> vitreous hemorrhage, fibrous tissue can contract –> retinal detachment and blindness

Question 9

What are the ocular manifestations seen in HTN?

Answer 9

copper-wire arterioles progress to silver-wire arterioles
AV nicking, narrowing of vessels
malignant HTN (diastolic >120) - exudates, cotton wool spots, flame shaped hemorrhages, macular edema, bilateral optic disc swelling if severe

Question 10

What are the ocular manifestations in thyroid dz?

Answer 10

unilateral or bilateral proptosis (exopthalmos)
exposure keratopathy –> foreign body sensation and irritation, can have EOM dysfxn and corneal damage
diplopia may require strabismus surgery
rarely compression of optic N will require decompression

Question 11

What are the ocular manifestations seen in sarcoidosis?

Answer 11

conjunctival non-caseating granulomas, eyelid granulomas
ant or post uveitis
optic neuropathy and CN palsies
dry eyes and lacrimal gland enlargement

Question 12

What are the ocular manifestations of malignancy?

Answer 12

basal cell carcinoma most often on eyelids
also squamous cell and sebaceous carcinomas
abnormal scaly, erythematous, or nodular lesion of eyelids
metastatic&raquo_space;> primary

Question 13

What are the ocular manifestations of AIDS?

Answer 13

retinopathy, retinal hemorrhages and cotton wool spots
CMV retinitis = hemorrhagic retinal necrosis w white brush border are at jxn of normal and affected retina (cottage cheese and catsup appearance)
necrotic retina has multiple atrophic holes, retinal detachment is common