Day 2 - Neuro4 Optho Flashcards
Light reflexes seen in both eyes if right eye CNII (optic nerve) damage prior to pretectal nucleus
Afferent - absence of constriction in either eye when light shown in right eye; both pupils constrict if light shown in left eye
Light reflexes seen in both eyes if right CN III (oculomotor) damage
Efferent - right eye not respond to light shown in either right or left eye; left eye constrict when light shown in either eye
Amblyopia - definition & cause
Decreased vision due to abnormal development of vision, usually from strabismus, cataracts, or refractive error prior to age 10
Causes/Types of strabismus
Esotropia, exotopia, diplopia, and/or refractive error not correctible with lenses
Tx Ambylopia
Vision training, Levidopa/Carbidopa; Patch functioning eye so force abnormal eye to correct
Causes of red eye match: (1) may indicate collagen vascular disease (2) potentially serious complication of corneal ulceration (3) Colored halos (4) Itching eye (5) Pre-auricular (6) Dry eyes (7) Shallow anterior chamber on slit lamp examp
(1) uveitis, scleritis (2) herpes simplex keratitis (e.g., herpes zoster infection involving eye) (3) Acute angle closure glaucoma (4) Allergic conjunctivitis (5) Viral conjunctivitis (6) Keratoconjunctivitis sicca (with Sjogren’s syndrome) (7) Acute angle closure glaucoma
Most common cause of conjunctivitis in first 24 h of life
Chemical conjunctivitis from antibiotic eye drops for all newborns (for undiagnosed chlamydia or gonorrhea)
Orbital cellulitis v. Peri-orbital cellulitis
Orbital cellulitis: more severe, proptosis, limitation of eye movement (opthalmoplegia), decreased vision, double vision, pain with eye movement
Tx orbital cellulitis
Immediate IV vancomycin plus IV ceftriaxone/cefotaxime for 3-5 days, then switch oral for 2-3 weeks; Consult ophthamology and ENT for consideration of possible surgical debridement
Most common causes of blindness in adult populations in US: (1) over age 55 (2) under age 55 (3) blacks of any age
(1) macular degeneration (2) diabetes mellitus (3) glaucoma
Distinctions & Tx for chalazion, anterior belpharitis, & hordeolum
Chalazion - inflx of internal meibomian sebaceous glands, eyelid swelling, usually self-limited, Tx surgical excision and/or intralesional steroid injection; Hordeolum - aka stye, inflx of external sebaceous glands, tender, red, swelling of eyelid margins, Tx hot compress few times a day, may need to excise and drain, antibiotic drainage; Anterior blepharitis - infx of eyelids and eyelashes 2/2 seborrhea, red swollen lid margins, dandruff on eyelashes; Wash lid margins daily with shampoo, scales with cotton ball, antibiotic may be applied to lid margins
Cataract p/w
Painless, progressive decrease in vision, manifested w/ difficulty drovomg at night/reading road signs/reading fine print; Usually bilateral; Often present as near-sightedness, diasabling possible glare with sun or oncoming headlights.
Tx angle closure glaucoma
Pressure lowering eye drops: beta blocker (Timolol) plus Iodipine, Pilocarpine; Oral Acetazolamide; If refractory, IV mannitol; Surgical option: Laser iriodotomy (hole in iris so aqueous humor can flow)
Tx corneal abrasion
Thorough eye exam, topical antibx 4x/day (until sx resolve), OTC lubricants, pressure patching not necessary; No role for general/pirate patching; Pain control PRN up to hourly - never prescribe topic anesthetic or steroids; 24 hr f/u for large abrasion, contact lens abrasion, or abrasion w/ diminished vision
35 yo F new onset rapid loss vision and pain when moving eye - Dx & Tx
Optic neuritis (w/ MS); Tx - IV steroids (500-1000 mg/day for several days)
