Disease Flashcards
Ectropion common with
- Involutional due to loss of muscle tone within orbicularis oculi
- paralytic
- Mechanical
- Cicatricial
- Congenital
What are optic disc drusens?
They are hyalin bodies located within the optic disc. Can be hereditary ( AD).
Gradually move anterior as pt ages.
Diagnosed with B-scan, appear hyperreflective
Common collagen vascular disorders that can cause optic disc edema
Rheumatoid arthritis
Systemic lupus erythematosus
Polyarteritis nodosa
Wegeners granulomatosis
What is Papillitis
Secondary to inflammation of the anterior optic nerve and will present with disc edema. Occurs 1/3 cases of optic neuritis.
What are signs of TRO
Unilateral optic disc edema
APD
Unilateral or bilateral proptosis, upper eyelid retraction
inferior and medial rectus effected first
Reduced color vision
Variable VA loss
Elevated IOP
Papilledema signs
Elevated optic nerve rim tissue Elevated or opaque NFL Paton's folds Hyperemia of optic disc CWS Exudates Splinter hemorrhage Absent SVP VF shows "Large Blind Spot"
IIH signs
Enlarged Blind Spot on VF
Diplopia due to CN VI palsy
Papilledema
Optic Atrophy ( late signs)
Reverse APD
Constriction of good eye during swinging flash light test when fellow eye has APD
Direct response of good eye is stronger than consensual response
In which cases of optic nerve abnormality, optic nerve appears normal
Retrobulbar Optic Neuritis.
Posterior ischemic optic neuropathy.
CN 3 palsy pathophysiology
- Lesion along the pathway of CN III
- Micro vascular infarcts from DM and hypertension.
- Trauma
- Aneurysm ( posterior communicating artery)
CN IV palsy common cause and symptoms
Trauma
Vertical Diplopia
Compensatory head tilt away from the side of the lesion
CN VI palsy cause/symptoms
Cause: Pseudotumor cerebri Horner's syndrome DM/HTN Trauma Tumor Symptoms: Head turn toward the affected side
Viral Conjunctivitis
Common cause is adenovirus. Patient highly contagious for 12-14 days Classic syndrome: 1-Acute non-specific follicular conjunctivitis 2-pharyngoconjunctival fever 3- EKC
Bacterial conjunctivitis
Signs;
Mucopurulent discharge.
Treatment:
Erythromycin ointment
Allergic conjunctivitis
Signs;
Watery, itchy , chemosis, allergic shiners.
Treatment:
Patanol
Follicles
- Blister like, more common in viral conjunctivitis.
- Avascular, white-gray nodules typically found in tarsal and fornix conjunctiva.
- Associates with Chlamydia, toxic or viral infections
Papilla
inflamed areas of elevated conj that have central vessel.
Can be small to very large ( as in GPC and VKC).
Non-specific but common in allergic or bacterial conjunctivitis.
psudomembrane
appears with severe conjunctivitis.
Blepharitis Treatment
Treatment:
warm compresses, lid scrubs, and artificial tears.
Erythromycine at bed time
Doxycycline can help by changing oil viscosity.(anti inflammatory and stops MMPs)
Chalazions
backed up lipids cause of blocked MGs
- non-infections (sterile) inflammations of the meibomian glands.
- painless and immobile
- recurrent, warrants possible malignancies ( sebaceous gland carcinoma)
Pre-septal cellulitis
Treatment:
Keflex, Augmentin
HSV infections
NO steroids..
Acyclovir, viroptic
Endophthalmitis is a.
serious infection inside the eye. Hypopon
Removal of acoustic neuroma may result in damage to the ……
Parotid gland and CN VII, causing facial paralysis on affected side
Neurotrophic keratitis is
Poor corneal sensitivity and wound healing. Secondary damage to V1
Congenital Gaucoma
Haab’s stria( folds in descemet’s membrane)
Band Keratopathy is associated with
Hypercalcimia Gout JIA Uveitis Dry Eye
Blue sclera is associated with what diseases?
Osteogenesis imperfecta or Ehler’s Danlos syndrome
What is Commotio Retinae
- Disruption of the RPE and photoreceptors outer segments causes of Trauma.
- Usually resolves without sequelae within 24-48 hours.
- known as Berlin’s edema
Purtscher’s Retinopathy
Associated with acute chest-compressing trauma
- diffuse retinal hemorrhage
- exudate
- cws
Perseptal Cellulitis
-ocular infection-( acute hordeolum, dacryocystitis)
-Systemic infection
-skin trauma
Signs:
Eyelid edema, Erythema, Ptosis, warmth, bump on eyelid
Orbital Cellulitis
1-Sinus Infection( Ethmoid sinusitis)
2-Orbital Infection ( dacryoaddentits, dacryocyctitis, progression of preseptal cellulitis)
3-Orbital Fracture
4-Dental Infection
Signs:
Red Eye, pain, Fever, Decreased vision, APD, proptosis, diplopia, pain on eye movement, EOM restriction
Diabetic and immunocompromised patients with orbital cellulitis may develop what
Mucormycosis (aggressive fungal infection)
Strongest risk factor for developing Thyroid eye disease
cigarette smoking
Thyroid eye disease occurs in
- 30-70% of patients with Graves thyroid disease
- most common cause of u or b proptosis in middle-aged patients
Thyroid eye disease signs
- inflammation and thickening of the EOMs resulting Optic nerve compression
- U or B proptosis
- upper eyelid retraction resulting in Dalrymple’s sign
- APD
- conj injection
- decreased color vision
- EOM involvement ( Im So Lazy) [ no muscle tendons]
- Corneal involvement ( SLK)
Von Graefe’s sign
upper eyelid lag during downgaze
Kocher’s sign
globe lag compared to lid movement when looking up
Orbital Psudotumor
-Affects young to middle aged patients
-idiopathic inflammatory process
-Acute onset of unilateral pain
-proptosis, EOM restrictions ( involved tendons), chemosis, hyperopic shift, optic nerve swelling (if posterior), increased IOP, reduced corneal sensation.
Testing: CT or MRI
Bilateral Orbital Pseudotumor in adults raises suspicion of which systemic diseases
systemic vasculitis:
Wegener’s granulomatosis
Polyarteritis nodosa
Lymphoma
Evisceration
Removal of the inner contents of the eye, sclera and other orbital content
Exenteration
removal of ALL contents of the orbit. including EOMs and orbital fat
Ocular Rosacea
Affects Sebaceous Glands ( Meibomian glands)
- chronic eyelid disease ( MGD, Blepharitis, recurrent hordeola/chalaza) resulting in ocular surface disease:
- Telangiectasia
- phyctenules
- staph marginal keratitis.
- SPK
- prelimbal corneal infiltrates.
Steven Johnson Syndrome
Type 3 hypersensitivity
-most commonly drug induced ( sufonamide,…)
-from infectious agents ( HSV, staph, adenovirus, pneumoonrpelbmnia)
Chronic signs: corneal scars, ulcers and NV, symblepharon.
Symblepharon associated with
Mucous membrane disorders:
- Ocular cicatricial pemphygoid (OCP)
- SJS
- severe AKC
Hordeolum
acute staph infection
- Internal
- External
- painfull
Trachoma signs
Entropion and Trichiasis ( causes corneal ulceration)
Meige’s syndrome is characterized by
BEB and lower facial abnormalities
The two prognostic factors for malignant melanoma
- depth of invasion
- lesion size
rodent ulcer is associated with
BCC
Causative agents for Dacryocystitis
- staphylococcus aurerus
- staphylococcus epidermidis
- Pseudomonas
- H. influenza in children
Dacryocystitis symptoms
Pain
Epiphora
Crusting
Occasional fever
Dacryocystitis signs
Edema and tenderness of the lacrimal sac below the medial canthal tendon
Primary Acquired Melanosis can progress to
Conjunctival Melanoma
Conjunctival intraepithelial Neoplasia
- known as Bowen’s disease or conjunctival squamous dysplasia
- can progress to sq cell carcinoma
Gonococcal conjunctivitis
- causative agent is Neisseria gonorrhea
- Thayer-Martin agar for diagnosis
- severe purulent discharge
- preauricular lymphadenopathy
- psudomembranes
Dennie's lines Atopy Shiners bilateral itching Inferior Papillae Corneal neovascularization, keratoconus, cataract common with Wilson disease Keratoconus is more common most common in young to middle aged adults ( teens to 40s)
Atopic Keratoconjunctivitis (AKC)
Shield ulcers bilateral prominent papillae Cobblestone papillae (upper palp conj) Trantas dots. intense itching, photophobia, thick mucus discharge common with young males
Vernal Keratoconjunctivitis (VKC)
VKC has strong association to
Atopic conditions
Asthma, eczema, seasonal allergic rhinitis.
40-75% of patients have eczema or asthma.
40-60% of patients have family history of atopy.
Trantas dots
Collection of epithelial cells and eosinophils near the limbus
Toxicity to topical mediation or CL solutions can result in
Allergic Conjunctivitis that is characterized by a Follicular reaction
GPC can results from
- Extended CL wear ( common with SH)
- Exposed sutures
- Glaucoma filtering bleb
- Scleral Buckles
- Ocular prosthetics
- classic signs; papillae > 0.3mm of upper tarsal conjunctiva, giant papillae > 1mm
Patient reports clear vision with CL and blurry with glasses, ghost images and diplopia.
topography shows irregular astigmatism.
what can you suspect
Corneal warpage
High riding CL
3 and 9 o clock staining is common complication with what type of CLs
Low-riding GP lenses.
Chlamydial-Adult Inclusion Conjunctivitis
- Caused by chlamydia serotypes D-K
- Acute Follicular conjunctivitis that becomes Chronic
- unilateral giant follicles in inferior fornices.
- preauricular lymphadenopathy and mucopurulent discharge possible.
- report chronic red eye started several weeks to months
- persist 3-12 months if left untreated and become bilateral.
Chlamydial- Trachoma Conjunctivitis
- Prevalent btw ages 1-5
- Caused by chlamydia serotypes A-C
- Follicular and papillary conjunctivitis
- preauricular lymphadenopathy
- mild superior pannus
- Arlt lines
- Herbert’s pits
Ophthalmia neonatorum
- acute conjunctivitis in newborns
- Chlamydia is the leading cause
Pterygium
- Fibrovascular growth of bulbar conjunctiva on to cornea
- destroys Bowman’s membrane
- leading to WTR
- Present Stocker’s line
Scleritis vs Episcleritis injection
bilateral and diffuse injection with Scleritis
unilateral and sectoral injection with episcleritis
Axenfeld’s nerve loop
Posterior ciliary nerve loop visible in sclera
Fine Keratic Precipitates (KPs)
Koeppe nodules
characteristics of non-grannulomatous etiology
Mutton-fat KPs
Iris stromal nodules ( Koeppe, Busacca)
characteristics of grannulomatous etiology
Stellate KPs are observed in
- Fuch’s heterochromic iritis
- Herpatic Uveitis
Congenital Syphilis Triad
- Hutchinson’s teeth
- deafness
- interestitial keratitis
- saddle nose deformity
- frontal bossing
Pars Planitis
- Chronic intermediate Uveitis
- characterized by inflammation over pars plana (snow banking)
Iris Malignancy
- From Iris Nevi
- located within iris STROMA tissue in the inf quadrant 80%
- diameter >3mm
Neurotrophic Keratopathy cause and symptoms
Herpes simplex Herpes zoster Diabetes LASIK Corneal findings worse than symptoms
Confluent SPK
Associated with what disease
UV Keratopathy
Symptoms are typically worse 6-12 hours
1 cause of aq deficient dry eye
Primary Non-sjogrens and secondary
Number one cause of dry eye
Intrinsic MGD
Extrinsic cause > vitamin A deficiency
Which layer of cornea does Keratoconus originate in?
Bowman ‘s layer
Hydrops on cornea
Tears in DESCEMET’s membrane that results in edema and rupture of epithelium
Posterior corneal dystrophies
Fuch’s
Posterior Polymorphous Dystrophy
Posterior Polymorphous Dystrophy is
20-30 yo patients
Metaplasia of endothelial cells
patches of vesicles is the hallmark sign
painfull Bullae and scarring
caused from stromal edema in Fuch’s
two conditio that have Corneal findings worse than symptoms
Neurotrophic Keratopathy Acanthamoeba Keratitis (early signs), (ring ulcer, late sign)
Chocolate agar for
N. Gonorrhea.
Haemophilus
heat-killed E.Coli agar
Acanthamoeba
Sabaroud’s agar
test for fungi
interestitial keratitis are
WBC in endothelium with diffuse newovascularization
most common cause of endothelitis
Disciform endothelitis
what are the common corneal sign in active HZ
Pseudodendritic keratitis
Bank Keratopathy associated with
Uveitis after trauma Gout hypercalcemia >>>calcium deposit at 3 and 9 oclock position
Krachmer’s spots
stromal corneal graft rejection associated with sub epi infiltrates
Kodadoust line
endothelium corneal graft rejection line characterized by WBCs on endothelium line.
Hyperopic shift
Radial Keratotomy
cortical cataract
CNVM
how much residual cornea is required after PRK
400nm
how much corneal thickness is required for LASIK
250um
myopic shift
Nuclear Sclerosis Scleral buckle surgery Diamox NSAIDs Topamax Oral Sulfonamides
Elsching pearls
type of posterior capsular opacification common in children who undergo cataract extraction.
common post-operative complication
PCO
CME ( Irvine-Gass syndrome, 6-10 weeks following surgery)
Bull’s eye maculopathy differential diagnosis
- Stargard’s disease
- cone dystrophy
- Chloroquine toxicity
- hydroxychloroquine toxicity
- thioridazine toxicity
Retinoschisis
splitting of OPL and INL resulting in elevation of the inner retina
common ocular finding of Behcet’s Disease is
Acute recurrent Hypopyon
Cluster headaches can cause
transient or permanent ipsilateral Horner’s syndrome
Early cataract
M A D
Myotonic dystrophy
Atopic dermatitis
Diabetes
Moore’s Lightning streaks
Lightning streaks which are Vertical Flashes of light seen in the peripheral visual field.
Occurs because of vitreous syneresis, traction on peripheral retina.0
What test are considered for foreign body diagnosis?
CT scan
B-scan
NO MRI
Canaliculitis presentation
Inflammation or infection of the canaliculi caused by bacterial, fungal or viral. Unilateral smoldering red eye Epiphora Mild tenderness/pain on nasal portion Swollen puncta ( pouting puncta) Mucopurulent discharge
Canaliculitis etiologies
Actinomyces israelii ( strep tothrix)- expression of yellow sulfur granules. Staphylococcus aureus Candida albicans Aspergillus Nocardia asteroides Herpes simplex Herpes zoster Surgery, trauma, neoplastic disorders
Allergic conjunctivitis presentation
Moderate or severe Ocular itching,hyperemia and tearing.
May also complain of associated rhinitis and sneezing.
GPC avrg length time for development secondary to CL
8 months
May occur early as 3 weeks.
Risk Factors:
-Extended wear hydrogel CL. High water ionic CL, High modulus of elasticity, poor replacement compliance.
Cause of decreased vision in AKC
Superficial punctuate keratitis.
Superior limbic keratoconjunctivitis
Chronic inflammatory reaction.
Associated with thyroid disease, Keratoconjunctivitis sicca, CL wear ( hypersensitivity reaction to preservative in CL solution or poor CL fit).
Symptoms: redness, foreign body sensation,frequent blinking
Corneal signs of HZO
Occurs in 65% pt with acute HZO; Punctate epithelial keratitis Pseudodendrtitic keratitis Anterior stromal keratitis Keratouveitis Endothelitis Neurotrophic keratopathy Less common signs; Exposure keratopathy, disciform keratitis, IK
Acanthamoeba corneal signs
Punctuate defect Whorl-like defect Pseudodendrtitic lesions Late signs: patchy, anterior stromal infiltrate becoming confluent over 2-3 months forming Ring ulcer. Also presenting radial keratoneuritis
Marginal keratitis
caused by a hypersensitivity reaction against staphylococcal exotoxins and cell wall proteins with deposition of antigen-antibody complexes in the peripheral cornea (antigen diffusing from the tear film, antibody from the blood vessels) with a secondary lymphocytic infiltration. The lesions are culture negative but S. aureus can frequently be isolated from the lid margins.
Phlyctenulosis
delayed hypersensitivity reaction to staphylococcal antigen; the most common systemic association is rosacea.
-Presentation is usually in children or young adults with photophobia, lacrimation and blepharospasm.
Thygeson superficial punctate keratitis
Symptoms :consist of recurrent attacks of irritation, photophobia, blurred vision and watering.
Signs • Mainly central, coarse, distinct, granular, greyish, slightly elevated epithelial lesions that stain with fluorescein. -A mild subepithelial haze may be present especially if topical antivirals have been used. •The conjunctiva is uninvolved and the eye is not hyperaemic.
Art lines
White scarring of the superior tarsal conjunctiva
Herbet’s pits
Depression of the limbal conjunctiva after resolution of limbal follicles
Chrysiasis
occurs secondary to the deposition of gold in the skin, lens, and cornea, causing a gray discoloration of the skin and brown/gold deposits in the deep stroma of the cornea.
Conditions that cause corneal blindness in the US
1-Trauma
2-HSV
Thygeson’s SPK signs
Bilateral
Small multiple asymmetric, gray white clusters of superficial intraepithelial raised “crumb like” central corneal lesions.
Aberrant regeneration of CN 3
Evaluation for trauma and tumor
-signs are lid -gaze and pupil-gaze dyskinesia
( patient will have upper eye lid retraction with downgaze and pupil construction with down gaze and addiction )
Ocular signs of Myotonic Dystrophy
Miotic pupil Ptosis External ophthalmoplegia "Christmas tree " cataract Pigmentary retinopathy
Type of cataract with Diabetic
Cortical cataract
- bilateral, multiple, gray white cortical crystalline lens opacities described as “snow flake opacities’”
- earlier and faster progression of senile NS and cortical cataract.
Cataract with Wilson disease
Green- brown opacities “ sun flower cataract”
Positive Seidel’s sign
Early post op period due to trauma
Suture failure
Valsalva maneuver
Hopotony
Loss of aq humor
IOP < 6
Causing anatomical and physiological changes
Common cause of elevated IOP in post op cataract patients
Retained viscoelastic materials
Potential cause of elevated IOP in post op patients
Retained viscoelastic Steroid response Pseudoexfoliation material Pupillary block Red blood cells in TM
PCO
41-51% of patients over 5 year old
Occurs within 2-6 months
Elsching pearls common in children
signs and symptoms of neovascularization
vary with the stage of the disease.
Early symptoms usually consist of decreased visual acuity from the underlying retinal condition, and, occasionally, from corneal epithelial edema and anterior chamber inflammation if retinal function is normal.
Later symptoms include ocular discomfort, brow ache, and nausea from inflammation and elevated IOP.
orbital bruit
represents increased blood flow through the collateral arterial system and intracranial arterial supply. In the correct clinical context, the presence of an orbital bruit should make the examiner suspect either a severe stenosis or occlusion of either the ipsilateral or the contralateral internal carotid artery (ICA).
Growth factors are found in
Glial cells
RPE cells
Vascular Endothelial cells
What improves macular capillary blood velocity in CME patients occurring after central retinal vein occlusion.
Systemic carbonic anhydrase inhibitors or corticosteroids, but not nonsteroidal anti-inflammatory drugs
