Common Eye Disorders

Question 1

Cataracts

Answer 1

• partial or complete loss of transparency of the crystalline lens or capsule
• pathogenesis not fully understood
• lens gets cloudy and dirty
• associated with: aging, UV exposure, drugs/meds (particularly steroids), injury/trauma, systemic conditions (DM)
• leading cause of blindness in the world (not US)

Question 2

Amblyopia

Answer 2

• Lazy eye
• An eye that cannot see 20/20 even with best correction
• unilateral or bilateral
• causes: refractive, strabismic, deprivation
• must be corrected before age 7 or reduced vision can be permanent

Question 3

Refractive amblyopia

Answer 3

• large or unequal refractive error
• bilat high myopia, hyperopia, or astigmatism may cause bilat decreased acuity
• anisometropic: one eye myopic the other hyperopic
• eyes may be aligned or strabismic
• tx: rx glasses for full time wear and possible “patching” treatment

Question 4

Types of Cataracts

Answer 4

• Senile: related to aging, a yellowing of crystalline lens
• Congenital: present at birth or within 1 yr, may or may not affect vision
• Traumatic: secondary to injury or surgery - AKA Rosette cataract
• Posterior subcapuslar: often associated with corticosteroid use (fast growing)
• Cortical: caused by UV exposure over time

Question 5

Cataract symptoms

Answer 5

• gradual blurring or fuzzy vision
• issues with driving at night, “halos” or “starburst”
• looking through a film

Question 6

Cataract treatment

Answer 6

• surgical replacement of the crystalline lens and implantation of corrective implant
• results in 96% chance of vision restoration

Question 7

Strabismus

Answer 7

• misalignment of both eyes so that both eyes cannot be directed toward the object of regard
• Can be true muscle misalignment or refractive
• Esotroipa and exotropia
• type of amblyopia

Question 8

Esotropia

Answer 8

• type of strabismus
• eyes turn in toward nose
• infantile is diagnosed within first 6 months
• often requires surgery
• refractive: most commonly high hyperopia
• Treatment: rx glasses full time, possible surgery

Question 9

Exotropia

Answer 9

• type of stabismus
• usually 1-4 years of age
• often intermittent
• eyes turn out
• can increase with age
• common and typically do not need surgery
• Treatment: glasses, vision therapy, and surgery if needed

Question 10

Deprivation Amblyopia

Answer 10

• physical deprivation of visual axis resulting in a failure to develop normal visual pathways
• congenital cataracts
• ptosis
• surgical intervention often required

Question 11

Ocular malignancies

Answer 11

• retinoblastoma
• choriodal melanoma
• basal cell carcinoma
• squamous cell carcinoma

Question 12

Retinoblastoma

Answer 12

• most common eye cancer in children
• spontaneously arises in the retina through a gene mutation or deletion of chromosomes
• average diagnosis by age 23 months
• if you see a white pupil they need to be treated immediately

Question 13

Clinical characteristics of retinoblastoma

Answer 13

• Leukokoria (white pupil) - most common
• strabismus
• elevted white mass with indistinct borders in the fundus
• treatment: localized chemo/radiation, photocoagulation laster/thermal therapy, enucleation (take out eye)
• Prognosis: most curable of all childhood cancer

Question 14

Chorodial Melanoma

Answer 14

• most common primary malignant intraocular tumor
• second most common type of primary malignant melanoma
• area of dark pigmentation in eye
• more common over 55
• often asymptomatic
• linked to UV exposure, light colored iris, previous hx of nervus
• Can do an ultra sound to look for the depth

Question 15

Chorodial melanoma clinical features

Answer 15

• arises from melanocytes within choroid
• can cause retinal detachments
• # 1 place to metastasize is liver (need to check liver enzymes)
• left untreated can result in death

Question 16

Chorodial melanoma tx

Answer 16

• localized chemo/radiation
• photocoagulation laser/thermal therapy
• enucleation

Question 17

Basal Cell

Answer 17

• most common eyelid cancer
• rarely metastasize outside of immediate area
• can spread to orbit, sinus, brain
• 70% on lower lid
• tx: surgical removal (biopsy)

Question 18

Squamous cell carcinoma

Answer 18

• 2nd most common malignant eyelid tumor
• most common conjunctival cancer
• rarely metastasizes
• can invade orbit, sinuses, and brain
• early intervention is key
• tx: surgical removal (biopsy)

Question 19

Hordeolum

Answer 19

• AKA stye
• external: obstructed and infected (staph) hair follicle and adjacent glands of Zies and Moll (typically can tx with hot compress)
• internal: obstructed and infected meibomian gland (require oral abx)
• clinical features: red, swollen eyelid, painful to tough (external form of pustule on lid)

Question 20

Hordeolum tx

Answer 20

• warm compresses used in both
• external: may rupture on its own with compresses, RX abx
• internal: systemic abx
• if internal is not treated properly it will form granulomatous scar tissue (ie Chalazion) - will need to cut out

Question 21

Chalazion

Answer 21

• noninfectious granulomatous obstruction of the meibomian gland to EYELID
• swollen nodule on eyelid, not painful to touch
• tx: warm compresses and systemic abx
• if it does not respond may need surgical intervention (corticosteroid injection or excision)
• If they can tolerate Doxy try that first

Question 22

Internal stye vs Chalazion

Answer 22

• internal syte: red, swollen and painful

- chalazion: palpable, but not painful or red

Question 23

Corneal abrasion

Answer 23

• disruption of the epithelial cells of the cornea
• clinical features: red, painful eye, photophobic, FB sensation, a recent hx of trauma to the eye, and positive corneal staining with NaFl

Question 24

Corneal abrasion managment

Answer 24

• depends on size and location
• remove FB if present
• usually heal with little to no complications 48-72 hours if superficial
• Abx or bandage contact lens
• If vegetative matter NO steroids (possible fungal infection)
• monitor to make sure ulcer does not develop

Question 25

Corneal abrasion staining

Answer 25

• lights up scratch

- if vertical marks then whatever scratch their eye is under their upper eyelid

Question 26

Corneal ulcer

Answer 26

• infectious disruption of corneal epithelium and stroma
• often seen in patients who abuse contact lenses
• red, painful eye, sensitive to light with a visible CORNEAL OPACITY
• positive NaFl staining
• tx: abx, special contacts
• if not treated properly can be visually devastating
• if unresponsive to abx after 5 days send for further work up (acanthamoeba, fungal)

Question 27

Hepres Zoster

Answer 27

• reactivation of varicella zoster
• red, burning, painful rash, can affect any part of the body
• can affect the eye (ophthalmic herpes)
• Hutchinson’s sign: lesions on tip of the nose ( more likely to develop lesions on cornea)
• red painful eye, sensitivity to light, dendritic lesion on the cornea
• tx: oral antivirals, topical antivirals
• if not treated properly can cause permanent scarring and vision loss

Question 28

Retinal detachment

Answer 28

• Rhegmatogenous, exudative, tractional
• common systems: FLASHES OF LIGHT, increase floaters, curtain falling over vision
• ocular emergency: timely intervention necessary to restore vision - if not eye will die

Question 29

Exudative retinal detachement

Answer 29

• serous elevation of the retina without a retinal break
• fluid accumulation is due to breakdown of the normal inner or out blood retinal barrier
• causes: neoplastic, inflammatory, congenital abnormalities, vascular

Question 30

Rhegmatogenous retinal detachement

Answer 30

• elevation of the retina from the RPE by fluid in the subretinal space due to full thickness retinal break or tear
• usually spontaneous
• more common in people with myopia (long eye) as they tend to have retinal thinning

Question 31

Tractional retinal detachement

Answer 31

• detached retina appears concave with a smooth surface, cellular and vitreous membranes exerting traction on the retina are present
• happening on the surface and ripping it forward
• causes: diabetic retinopathy, sickle cell retinopathy, toxocaris, trauma

Question 32

Retinal detachment tx

Answer 32

• dependent on location and size
• Cryo-therapy: used for small holes or tears. “freezing” of hole or tear to create scar tissue to prevent progression to full detachment
• scleral buckle: used for large tears and full detachment. Scar tissue formed using cryo or laser then retina is sewn to actual “buckle” made of plastic silicone. Often requires vitrectomy (PPV)
• prognosis: visual outcomes dependent on size of detachment and timely intervention