Common optho problems

Question 0

Gonococcal conjunctivitis

Answer 0

Emergency! corneal involvement can lead to perforation and blindness
Tx: IM ceftriaxone, PO ciprofloxacin or PO ofloxacin

Question 1

Conjunctivitis: common pathogens

Answer 1

Streptococci, staphylococci, Haemophilus influenzae, Moraxella, Pseudomonas
Neisseria gonorrhoeae
Chlamidya trachomatis
Adenovirus

Question 2

Chlamidya trachomatis conjunctivitis

Answer 2

Recurrent epithelial keratitis in childhood
Trichiasis, corneal scarring, entropion
Leading cause of preventable blindness worldwide
Dx: giemsa stain, chlamydial cultures
Tx: azithromycin, tetracycline, or erythromycin x 3-4 weeks

Question 3

Orbital cellulitis pathogens

Answer 3

Strep, staph, H influenzae

Mucor and rhizopus in diabetics

Question 4

Orbital cellulitis vs preseptal cellulitis

Answer 4

Orbital cellulitis: restricted eye movements, decreased visual acuity, diplopia, proptosis

Question 5

Treatment of mucormycosis or rhizopus orbital cellulitis

Answer 5

IV amphotericin B and surgical debriedment

Question 6

Treatment of malignant otitis externa

Answer 6

IV ciprofloxacin (need pseudomonal coverage)

Question 7

Dacrocystitis

-what is it, symptoms, causes

Answer 7

Infection of the lacrimal gland

sx: sudden onset of pain and redness in the medial canthal region, sometimes w/ purulent discharge
- caused by S aureus and beta-hemolytic strep
- responds to systemic antibiotics

Question 8

Episcleritis

-what is it, sx, exam

Answer 8

Infection of the episcleral tissue between conjunctiva and sclera

Sx: acute onset of mild to moderate discomfort, photophobia, watery discharge

Exam: diffuse or localized bulbar conjunctival injection

Question 9

Hordeolum

Answer 9

Abscess located over the upper or lower eyelid 2/2 S aureus

-localized red, tender swelling of the eyelid

Question 10

Chalazion

Answer 10

Chronic granulomatous inflammation of the meibomian glands

• hard painless lid nodule
• lid discomfort

Question 11

Orbital cellulitis vs. preseptal cellulitis

Answer 11

Orbital: pain with EOM, vision abnormalities, opthalmoplegia, proptosis

Both: eyelid erythema, edema, tenderness; leukocytosis; fever

Question 12

HSV keratitis

Answer 12

Causes corneal blindness
-pain, photophobia, blurred vision, tearing, redness

Causes: sun exposure, outdoor occupation, fever, or immunodeficiency

Exam: corneal vesicles and dendritic ulcers

Question 13

Bacterial keratitis

Answer 13

Common in contact lens wearers, s/p corneal trauma, or entry of foreign body

Cornea appears hazy w/ central ulcer and adjacent stromal abscess

Question 14

Who does fungal conjunctivitis affect?

Answer 14

Agricultural workers or immunocompromised patients

Question 15

Cavernous sinus thrombosis

Answer 15

Headache, periorbital edema, exopthalmos, chemosis

Fundoscopy: papilledema and dilated tortuous retinal veins

Question 16

Symptoms of optic neuritis

Answer 16

Unilateral eye pain and acute vision loss and afferent pupillary defect
-a/w MS!!

Question 17

Macular degeneration

Answer 17

Affects central vision: distorted vision w/ central scotoma
Smoking increases risk

Fundoscopy:

• atrophic: multiple sores in the macular region
• exudative: new blood vessels that may leak, bleed, and scar the retina

Question 18

Retinal detatchment

Answer 18

Unilateral blurred vision that progressively worsens

Question 19

Glaucoma symptoms

Answer 19

Peripheral visual field defects

Question 20

Vitreous hemorrhage

Answer 20

Sudden loss of vision and floaters in the visual field

-diabetic retinopathy is most common cause

Question 21

Allergic conjunctivitis

Answer 21

Acute hypersensitivity caused by environmental allergens

• itching, hyperemia, tearing, conjunctival edema, eyelid edema
• photophobia and a burning sensation
• usually family or personal hx of asthma, atopic dermatitis, urticaria

Question 22

Atopic keratoconjunctivitis

Answer 22

Ocular allergy

-itching, tearing, thick mucus discharge, photophobia, blurred vision

Question 23

Toxic conjunctivitis

Answer 23

Direct damage to ocular tissues from drugs

-hx of aminoglycosides, glaucoma drops, artificial tears, or contact lens solution

Question 24

Blepharitis

Answer 24

Chronic inflammatory condition involving lid margins bilaterally

• anterior blepharitis: crusty discharge seen clinging to the lashes
• posterior blepharitis: hyperemic lid margins w/ telangiectasias