Eye

Question 0

considerations in contact lens wearers: eye

Answer 0

bacterial corneal ulcers

psudomonal infections - rx fluoroquinolone

visual acuity w/ or w/o contacts - consider pinhole vision testing

Question 1

Chemical burn eye

Answer 1

Copious irrigation until eye returns to a neutral pH

Repeat pH measurement at 5 & 10 mins after ceasing irrigation

Question 2

what does pinhole vision testing do?

Answer 2

the pinhole allow only parallel light to fall on the macula, thereby reducing the refractive error and allowing an estimate of the person’s corrected visual acuity

Question 3

Remove contacts for fluorescein?

Answer 3

Always remove contact lenses, fluorescein will cause permanent staining of the lenses

Question 4

Tonometry (IOP) is contraindicated in what setting?

Answer 4

Globe rupture

Question 6

What to prescribe for mild pre septal cellulitis - outpt

Answer 6

Augmentin (peds 20mg/kg BID)
First gen cephalosp. - eg Keflex

2. Hot compress
3. Close follow up 24-48 hrs

Question 6

Preseptal cellulitis: clinical presentation

Answer 6

• us. assoc with URI esp para nasal sinusitis
• May result from eyelid probs like: hordeolum, chalazion, insect bites, trauma
• upper resp symptoms
• low grade fever
• redness and swelling of eyelid
• excessive tearing
• EYE itself is not involved!
• visual acuity preserved
• pupillary rxn preserved
• full painless ocular motility

Question 7

For young child and severe cases: Rx preseptal cellulitis

Answer 7

1. Consider hospitalization
2. Third generation cephalosp. -eg ceftriaxone (in peds 50 mg/kg IV q12H or cefuroxime 50 mg/kg IV q8H) + vancomycin (if MRSA suspected)
3. Optho consult in young children

Question 9

orbital cellulitis

Answer 9

• occurs most freq from spread of para nasal sinusitis
• ethmoid sinus most freq implicated

suspect if:
-proptosis
impaired extraocular mvmts 
pain w/ eye mvmt
decreased visual acuity
chemosis
afferent pupillary defect

Question 10

preseptal cellulitis: organisms responsible

Answer 10

staph and group A strep

Question 11

Hypopyon

Answer 11

WBC in anterior chamber

Question 12

Hyphema

Answer 12

Rbcs in anterior chamber

Question 13

Central retinal artery occlusion

Answer 13

Pale retina with a normal colored macula

Question 14

Central retinal vein occlusion

Answer 14

Blood and thunder appearance (diffuse hemorrhages and dilated blood vessels)

Question 15

Cavernous sinus thrombosis

Answer 15

CNs II, III, IV and VI traverse the cavernous sinus

VI runs freely in the sinus, so it is the first to be affected
The others run along the lateral side
Proptosis, chemosis and eye pain may occur