EM opthalmology

Question 1

most common mechanism causing congenital ptosis is

Answer 1

myogenic, due to a striated muscle fiber defect of the Levator palpebrae superiors muscle.

Question 2

next most common cause of congenital ptosis is

Answer 2

neurogenic

Question 3

A chalazion is an inflammatory granulomatous nodule of the meibomian gland. The nodules are firm and nontender, and may be found on the upper or lower eyelid. If the lesion is large enough to distort the eyelid, then

Answer 3

surgical excision is indicated. At times steroid injections are used to affect a resolution.

Question 4

____ are indicated when a hordeolum, or stye, is present. This lesion is a painful erythematous infection of the glands of the eyelid. Staphylococcal aureus is the usual etiologic agent. A hordeolum typically points and drains.

Answer 4

Hot compresses and perhaps a topical antibiotic ointment

Question 5

A traumatic hyphema, or the presence of blood in the anterior chamber, can occur with either blunt or penetrating trauma. It appears as a bright red or dark red fluid level between the cornea and the iris or as a diffuse murkiness of the aqueous humor. Pain is a prominent symptom.

Answer 5

Ophthalmologic consultation should be sought.

Question 6

Visualization of the cornea with a blue filtered light, application of topical antibiotics, patching of the affected eye and application of a cycloplegic agent would be indicated in the case of a

Answer 6

superficial corneal laceration

Question 7

_____ is an inflammation of the lid margins, which is characterized by redness, scaling or crusting lesion. It is initially manifested by itching, irritation and burning sensation. It is recurrent, chronic and usually bilateral. In cases of the seborrheic type, the scales are greasy, erythema is less, and ulceration seldom occurs.

Answer 7

Blepharitis

Question 8

____ is a condition in which the lid margin is directed inwards. It usually causes discomfort and corneal damage because the eyelashes are also turned inwards. It is most commonly caused by scarring due to inflammation seen in trachoma or from Steven-Johnson-syndrome. Surgery is effective.

Answer 8

Entropion

Question 9

_____ is when the lid margin is turned outwards or everted; it is associated with an overflow of tears, maceration of the lid skin, inflammation of exposed conjunctiva, and/or superficial exposure keratopathy. Scarring from inflammation, burns, trauma, or orbicularis muscle weakness from facial palsy are the common causes. Surgical correction is necessary to protect the cornea.

Answer 9

Ectropion

Question 10

child, with wide epicanthal folds, whose corneal light reflex and cover tests are normal, but who still gives the impression of eyes turning inward, is a good example of ______. A wide nasal bridge, narrow-set eyes, or prominent epicanthal folds will give the illusion of esotropia (eyes turning in) because less sclera is visible in the nasal aspect of both eyes.

Answer 10

pseudostrabismus.

Question 11

_____ is when the ‘weak’ eye drifts away from the focal point and the resulting visual input is suppressed by the brain. If not corrected, the weak eye will eventually lose the ability to develop normally.

Answer 11

Strabismus. The weak eye might drift medially (esotropia), laterally (exotropia), upward (hypertropia), or down (hypotropia).

Question 12

Amblyopia means decreased acuity for non-anatomic reasons

Answer 12

Strabismus is a type of amblyopia where 1 eye ‘drifts’ off target

Question 13

is a bilateral recurrent inflammation of the conjunctiva that usually occurs during warm weather. It occurs mainly in the 5 to 20-year-old age group, affecting boys more commonly than girls.

Answer 13

Vernal conjunctivitis. There is usually a family history of atopy. Cobblestone papillae with milky exudates are characteristic, as is the finding of eosinophils on the smear.

Question 14

combination of uveitis and an elevated antinuclear antibody titer should make the reader think of ______. Although its definition revolves around the arthritis component - an idiopathic synovitis involving the peripheral joints with soft tissue swelling and effusion - it is possible (as is true with this girl) that the disease may begin with uveitis alone, and no arthritis.

Answer 14

juvenile rheumatoid arthritis (JRA), recently re-named juvenile idiopathic arthritis.

Question 15

initial goal of management is to provide timely recognition of injury to allow for management and stabilization of the condition. On the sidelines, this should always begin with ______, while taking a thorough history. This can be done by having the player read words or letters or count fingers held at a 2-5 foot distance.

Answer 15

evaluation of visual acuity with corrected vision in place

Question 16

Minor injury to the eye is most likely to cause a corneal abrasion. These occur often in children of all ages and usually result in loss of one or several of the layers of the corneal epithelium.

Answer 16

Being richly innervated, a corneal abrasion will cause mild to severe discomfort depending on the size of the defect along with photophobia, tearing, irritability, blurry vision, conjunctival injection, blehpharospasm, irregular red reflex, and fluorescein staining of the defect.

Question 17

9-year-old male reports he was poked in the eye accidentally by a classmate with a pencil at school today. There was immediate pain, tearing, and blurry vision and his mother was called to take him home. He says it still hurts though the tearing and blurriness have subsided. On exam, his pupils are equal and reactive, extraocular movements intact, sclera is mildly injected, visual acuity is 20/30 in both eyes, and there is no foreign body seen.

Answer 17

Stain cornea with fluorescein

Question 18

Ophthalmia neonatorum is a form of conjunctivitis occurring in infants younger than 4 weeks. The usual incubation period for C. trachoma tis and N. gonorrhoeae.is

Answer 18

5-14 days and 2-5 days

Staphylococcus aureus can also cause ophthalmia neonatorum.

Question 19

Conjunctivitis due to silver nitrate drops usually occurs

Answer 19

within 6-12 hours after birth.

Question 20

Worldwide, ____ is the leading cause of infectious blindness due to

Answer 20

trachoma, Chlamydia trachomatis. Untreated or chronic infection results in a chronic follicular keratoconjuntivitis with corneal neovascularization.

Question 21

_____ is the most common primary malignant intraocular tumor of childhood. It usually appears quite early in the first 5 years. Leukocoria, a white or Cat’s eye reflex in the pupil is the most frequent finding. There may also be strabismus due to vision impairment.

Answer 21

Retinoblastoma. Ocular inflammation, intraocular hemorrhage, glaucoma or heterochromia iridis may be seen. On fundoscopic exam, the tumor may appear as a small to large white mass depending on its stage.

Question 22

Though leukocoria may be seen in retrolental fibroplasia or advanced stage of retinopathy of prematurity it is predominantly a disorder in preterm, low birthweight infants who received supplemental oxygen in the newborn period.

Answer 22

These infants are susceptible due to the immaturity and subsequent damage of developing retinal vasculature. If the retina goes through various stages to ischemia and neovascularization, leukocoria may be seen representing retinal detachment and a subsequent membrane formation.

Question 23

_____ are retinal findings hallmarking hamartomatous disorders such as tuberous sclerosis. The distinctive ocular lesion is a yellowish multinodular cystic lesion arising from the retina or disc. Similar lesions can occur in neurofibromatosis.

Answer 23

Phakomata

Question 24

_____ is a progressive degeneration of the retina. It is characterized by pigmentary changes, arteriolar attenuation, some degree of optic atrophy and progressively deteriorating visual impairment. Granularity or mottling of the retinal pigment pattern or distinctive focal pigment aggregates can be seen fundoscopically.

Answer 24

Retinitis pigmentosa

Question 25

_____ is a congenital disorder involving splitting of the retina into an inner and outer layer. Usually good vision is maintained. An elevation of the inner layer of the retina can be seen.

Answer 25

Retinoschisis

Question 26

____ indicates diplopia of double vision, this action eliminates the second image. It is also a common occurrence in intermittent exotropia especially under brightly illuminated conditions or may be associated with other types of strabismus.

Answer 26

Closing or covering one eye.

Headaches are not caused by eye diseases or conditions if the eyes remain white and are not otherwise inflamed. Uveitis or glaucoma may produce eye pain localized to the eye or side of the face. The eyes in these circumstances will be inflamed to some degree.

Question 27

____ in infants and children more commonly occurs due to trauma, secondary to other abnormalities like myopia, or after cataract surgery. It can also occur in diabetes, sickle cell disease, and retinopathy of prematurity. Presenting signs can be loss of vision, secondary strabismus (squint), nystagmus, and leukocoria (white pupillary reflex).

Answer 27

Retinal detachment.

Also ultrasonography and neuroimaging may be required to establish the cause of detachment.

Question 28

____ usually manifests during the first 3 years of life. The classical triad of symptoms of congenital glaucoma are epiphora (excessive lachrymation), photophobia (sensitivity to light), and blepharospasm (squeezing of the eyelids). These symptoms are due to corneal irritation.

Answer 28

Congenital glaucoma (elevated intraocular pressure). As the cornea and sclera are more elastic during early childhood, the elevated intraocular pressure therefore leads to expansion of the eyeball, including the cornea, and development of buphthalmos (ox eye), which means a large eye. This leads to corneal edema and conjunctival congestion. The cornea may become cloudy. There is no white pupillary reflex or calcification in the globe seen on x-ray of skull.