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1
Q

chronic eye condition characterized by inflammation of the eyelids w a common complaint of irritation

A

blepharitis

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2
Q

inflammation at the base of the eyelashes in young female

A

anterior blepharitis

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3
Q

fibrinous scales and crust around the eyelashes

A

staphylococcal anterior blepharitis

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4
Q

dandruff like skin changes around the base of the eyelids, resulting in greasy scales around the eyelashes

A

anterior seborrheic blepharitis

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5
Q

inflammation of inner portion of eyelid at level of meibomian glands assoc w rosacea or seborrheic dermatitis

A

posterior blepharitis

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6
Q

path of anterior blepharitis

A

lid colonizing staphylococcal bacteria

  • direct infx
  • rx to staph exotoxin
  • allergic response to staph antigen
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7
Q

what is associated with posterior blepharitis

A

rosacea-plugging/hypertrophy of sebaceous glands

seborrheic dermatitis- inflame of meibomian glands and tear film instability

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8
Q

path of posterior blepharitis

A

hyperkeratinization of meibomian gland

  • inc concern of free fatty acids and lipids
  • impaired lipid layer of tear film and instability of tear film
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9
Q

pt presents with irritation, red eyes, gritty feeling, and blurred vision

A

blepharitis

*no visual disturbance

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10
Q

pt presents with excessive tearing, burning sensation, red/swollen eyes with light sensitivity

A

blepharitis

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11
Q

what can provoke or exacerbate symptoms of blepharitis

A

smoking, allergens, contacts, retinoids

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12
Q

tx of blepharitis

A

alleviate symptoms/good lid hygiene (warm compress, lid massage/washing)
abx
-topical:azithromycin,erythromycin,bacitracin
-oral: doxy or tetra cycline

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13
Q

benign, self limited/easily tx red eye w discharge

A

conjunctivitis

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14
Q

what is always characterized by red eye

A

conjunctivitis

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15
Q

what causes bacterial conjunctivitis

A

staph aureus (mc adults)
strep pneumo
H influ
M cat

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16
Q

how is bacterial conjunctivitis spread

A

direct contact w pt or secretions or contaminated objects/surfaces

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17
Q

what type of conjunctivitis is sight threatening and requires immediate ophthalmic referral

A

bacterial w N. gonorrhea

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18
Q

what causes viral conjunctivitis

A

adenovirus

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19
Q

part of viral prodrome followed by adenopathy, fever, pharyngitis, URI

A

viral conjunctivitis

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20
Q

path of allergic conjunctivitis

A

airborne allergens cause mast cell degranulation and release of histamine, eosinophil/platelet activating factor
IgE

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21
Q

path of non infx/ non allergic conjunctivitis

A

mechanical/chemical irritation

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22
Q

pt tells you that woke up with crusting of the eye and during the day had redness, irritation and discharge with diffuse injection of conjunctivae

A

conjunctivitis

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23
Q

will cause 360 involvement of bulbar conjunctiva but will spare the tarsal conjunctiva

A

kertitis, iritis, angle closure glaucoma

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24
Q

pt has redness, thick yellow discharge and complain their eye is stuck shut

A

bacterial conjunctivitis

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25
Q

pt has redness, watery discharge and complain of sandy feeling

A

viral conjunctivitis

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26
Q

pt has b/l redness, watery discharge, and itchy

A

allergic conjunctivitis

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27
Q

when do you need cx for bacterial conj

A

if concerned about gonorrhea

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28
Q

pt says they are unable to open eye, have a foreign body sensation, and corneal opacity

A 
ulcerative keratitis (pseudo)
watch w contacts- if so get rid of them
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29
Q

what are you concerned about if pt has reduction of visual acuity

A

infx keratitis, iritis, angle closure

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30
Q

pattern of injection in which pt has redness pronounced in ring at limbus concerned about

A

called ciliary flush

infx keratitis, iritis, angle closure

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31
Q

concerned w if have photophobia

A

infx keratitis, iritis

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32
Q

concerned w if have corneal opacity

A

infx keratitis

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33
Q

concerned w if have fixed pupil

A

angle closure

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34
Q

concerned w if have severe HA w N

A

angle closure

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35
Q

tx bacterial conj

A

erythromycin ointment or trimethoprim polymyxin B

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36
Q

tx viral conj

A 
antihistamine
decongestant drops (OTC)
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37
Q

tx allergic conj

A 
antihistamine
decongestant drops (OTC)
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38
Q

when can pt return to school/work with bacterial conj

A

24 hrs of abx (erythromycin)

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39
Q

when can pt return to school/work w viral conj

A

after discharge cleared

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40
Q

common eye injury from trauma, foreign bodies or improper contact lens use

A

corneal abrasion

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41
Q

severe eye pain and fb sensation after cat scratched eye

A

traumatic corneal abrasion

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42
Q

pt presents to ER with eye pain that is so bad couldn’t drive himself and with photophobia or foreign body sensation that didn’t go away after trying to wash it out

A

corneal abrasion

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43
Q

size of pupil with corneal abrasion

A

normal to small

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44
Q

visual acuity with corneal abrasion

A

normal, slightly abnormal, grossly abnormal depending on where abrasion is on visual axis

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45
Q

white spots or opacity in contact lens wearer

A

corneal ulcer from bacterial infx

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46
Q

what is used to confirm dx of corneal abrasion

A

fluorescein exam

  • cobalt blue filter
  • woods lamp
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47
Q

anesthesia for corneal abrasion

A

proparacaine/tetracaine

  • relief win 30-60s
  • lasts 10-20min
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48
Q

when should pt have same day ophthalmic exam w corneal abrasion

A

corneal infiltrate, white spot, opacity, can’t remove foreign body, hypopyon, purulent discharge, drop in vision, not healed in 3/4 days

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49
Q

pain control tx for small corneal abrasion

A

ophthalmic nsaids, oral nsaids, tylenol #3, percocet (24hr), lacri-lube (OTC)

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50
Q

pain control tx for lg corneal abrasion

A

nsaids/narcotics (48hrs)

cycloplegic drops

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51
Q

how do cycloplegic drops work in tx lg corneal abrasion

A

parasym that inhibit mitotic (pupil constricting) response to light
won’t relieve FB sensation

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52
Q

tx corneal abrasion w contact lens

A

abx drops

  • ofloxacin
  • tobramycin
  • ciprofloxacin
  • dont patch
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53
Q

types of benign lesions

A

xanthelasma
chalazion
hordeolum
pterygium

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54
Q

pt comes to office with soft yellow plaques medial aspects both eyes

A

xanthelasma

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55
Q

xanthelasmas are a classic feature of what ds

A

primary biliary cirrhosis

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56
Q

tx xanthelasma

A

benign lesion so only for cosmetic reasons

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57
Q

inflam lesion dev from obstructed zeis or meibomian gland

A

calazion

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58
Q

pt presents w painless, rubbery nodular lesion that started as swelling and erythema of eyelid

A

calazion

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59
Q

what often calms and scars into hard chalazion

A

inflamed hordeolum

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60
Q

tx calazion

A

warm compress

ophthalmo-I/C or direct glucocorticoid injection

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61
Q

what should you check for if pt has persistent or recurrent calazions

A

cancer

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62
Q

internal/external acute purulent inflame of eyelid

A

hordeolum

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63
Q

what causes hordeolum

A

staph aureus

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64
Q

tx hordeolum

A

warm compress

oral abx cover staph- keflex

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65
Q

triangular wedge fibrovascular conj tissue starts nasal conj and extends to cornea

A

pterygium

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66
Q

mc symp pterygium

A

redness and irritation

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67
Q

tx pterygium

A

artificial tears
maybe nsaids/topical decongestants
effects vision–> surgical excision by ophthal

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68
Q

pt presents with blurred vision and glare. complain of difficulty reading fine prints and sees halos when driving at night

A

cataract

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69
Q

leading cause of blindness in the world

A

cataracts

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70
Q

types of age related cataracts

A

nuclear, cortical, posterior subcapsular

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71
Q

dx congenital cataract

A

dx babies-absense red reflex

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72
Q

patho cataracts

A

cells of lens don’t shed off dead cells

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73
Q

toxic exposures that play role in cataracts

A 
smoking/UV***
age
alcohol
steroids
trauma
dm
malnutrion
pref eye infx
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74
Q

prevention cataracts

A

healthy diet
stop smoking
postmenopausal estrogen
antioxidant vitamins

75
Q

when is surgery for cataracts needed

A

interferes w ability to perform activities of daily living

lens removed replaced with plastic lens

76
Q

pt presents sagging lower eyelid, excess tearing, dryness, irritation

77
Q

tx exctropion

A

artificial tears, lacri-lube

surgery to shortern/tighten lower lid

78
Q

rolled in eyelid with redness, pain and sensitivity to light

79
Q

tx entropion

A

surgery- tightening or sutures

80
Q

nasolacrimal duct obstruction

A

dacryostenosis

81
Q

infx/inflam of lacrimal sac

A

dacryocystitis

82
Q

infx/inflam of lacrimal gland

A

dacryoadenitis

83
Q

mc cause of persistent tearing and ocular discharge in kids

A

dacryostenosis

84
Q

dacryostenosis patho

A

nasolacrimal canal incomplete

85
Q

infant with persistent tearing, matted eyelashes, and redness

A

dacryostenosis

86
Q

what will happen when palpate lacrimal sac w dacryostenosis

A

reflux of tears/ mucous discharge at punctum if persistent tearing

87
Q

tx for dacryostenosis

A

*lacrimal sac massage downward- force tears from sac into duct
2-3x day
-lacrimal duct probing

88
Q

swelling, redness, tenderness on lateral/proximal aspect of nsoe

A

dacryocystitis

89
Q

dacryocystitis organisms

A

alpha-hemolytic strep
staph epidermis
staph aureus
MRSA

90
Q

tx mild dacryocystitis

A

warm compress

systemic abx- clinda

91
Q

tx severe dacryocystitis

A

admit
vanco and 3rd gen ceph
I/D

92
Q

pt w swelling, erythema, pain temporal aspect of upper eyelid

A

dacroadenitis

93
Q

virus causes of dacryoadenitis

A

measles, mumps, influenza, herpes, cmv

94
Q

bacterial causes of dacryoadenitis

A 
staph aureus (mc)
strep pyogenes
h flu
chlamydia
gonorrhea
95
Q

tx dacryoadenitis

A

warm compress
analgesics
abx- cephalexin or bactrim/clinda if mrsa

96
Q

pt w red eye, fb sensation, can’t keep eye open, pain dealing with cornea

97
Q

bacterial causes keratitis

A

staph aureus, pseudomonas, strep pneumo, diphtheroids

98
Q

viral causes keratitis

A

herpes

adenovirus but usually conj

99
Q

pt w fb sensation, can’t keep eye open, photophobia, white spot

A

bacterial keratitis

100
Q

pt w red eye, fb sensation, photophobia, watery discharge

A

viral keratitis

101
Q

what will you see with fluorescein viral keratitis

A

branching opacity

102
Q

tx bacterial keratitis

A

urgent ophth referral

topical ophth abx

103
Q

tx viral keratitis

A

self limited

104
Q

path of uveitis

A

infx- cmv, toxoplasmosis, cat scratch, west nile, herpes
systemic inflam-autoim/rheum
cancer-lymphoma

105
Q

pt presents w red eye, +/- pain, visual disturbance, exudates, inflame post structures

106
Q

tx uveitis

A

urgent referral
infx- antiviral agents and topical steroids
non infx- topical steroids/systemic steroids

107
Q

uveitis complications

A 
calcium in epithelia of cornea
adhesion iris to lens
cataract
glaucoma
macular edema
108
Q

infx involving fat and ocular muscles around eye

A

orbital cellulitis

109
Q

with orbital cellulitis what must you distinguish between

A

preseptal=milder tx outpt

orbital=serious admit/iv abx

110
Q

pt presents with ophthalmoplegia, pain w eye movement, and proptosis

A

orbital cellulitis

111
Q

bacterial causes orbital cellulitis

A

staph aureus (mc)
strep
mrsa

112
Q

fungal causes of orbital cellulitis

A

mucorales

aspergillus

113
Q

pt w eyelid swelling, erythema, ocular pain

A

preseptal orbital cellulitis

114
Q

pt w eyelid swelling, inflam ocular muscles, pain w movement, proptosis, diplopia

A

orbital cellulitis

115
Q

how to differentiate between preseptal and orbital cellulitis

A

ct scan of orbits/sinuses

116
Q

tx preseptal/periorbital cellulitis

A

clinda or bactrim plus amoxil, augmentin, omnicef for 7-10d

improve 24 hr

117
Q

tx orbital cellulitis

A

admit and consult
vanco IV plus ceftriaxone, cefotaxime, ampicillin-sulbactam or pipercillin-taxobactam
might add metronidazole
24-48 hr then oral clinda

118
Q

serious complications of orbital cellulitis

A

cavernous sinus thrombosis, intracranial extension of infix, vision loss

119
Q

optic neuropathy related to intraocular pressure that can lead to vision loss

120
Q

progressive visual field loss followed by central loss due to optic nerve axon loss

A

open angle glaucoma

121
Q

significant elevated intraocular pressure w painful red eye

A

angle closure glaucoma= emergency

122
Q

path of angle closure glaucoma

A

lens too far forward pushing against iris

123
Q

how does open angle glaucoma present

A

asymp

progressive vision loss- tunnel vision

124
Q

pt presents with rapid onset of dec vision, severe eye pain, and HA

A

angle closure glaucoma

125
Q

pt presents with rapid onset severe eye pain, N/V, mid dilated pupil

A

angle closure glaucoma

126
Q

dx open angle glaucoma

A 
elev IOP (norm 8-21)
optic nerve damage
thinning/cupping disc rim
visual field defect
norm ant chamber
127
Q

dx angle closure glaucoma

A

by ophthalmologist w gonioscopy

128
Q

tx open angle glaucoma

A 
meds inc outflow
-prostaglandins (latanoprost, bimatoprost)
-alpha agonists (brimoidine)
-cholinergic agonists
meds dec prod
-alpha agonists
-beta blockers (timolol, bextalol)
-carbonic anhydrase inhib
trabeculoplasty
surgery- filtration bleb
129
Q

tx angle closure glaucoma

A

consult win 1 hr
timolol 0.5% 1 drop after 1 min then iodine 1% 1 drop after 1 min pilocarpine 2% 1 drop
reassess 30min
laser peripheral iridotomy-holes in iris

130
Q

loss of central vision in older adults due to degeneration of central portion of retina

A

macular degeneration

131
Q

subretinal drusen deposits on macula

A

dry macular degeneration

132
Q

growth ban blood vessels in sub retinal space

A

wet macular degeneration

133
Q

path of dry macular degeneration

A

inflamm/chronic infx/tissue ischemia

134
Q

path of wet

A

vascular endothelial growth factor (VEGF) plays role

135
Q

risk factors macular degeneration

A 
age (50)
smoking
fam hx
cardiovasc ds
diet- vit c/e, veg (dec risk)
cataract surgery
aspirin use
136
Q

pt presents w gradual loss vision and difficulty reading and driving so needs magnifying glass

A

dry mac deg

137
Q

pt presents w acute loss central vision and distortion of straight lines

A

wet mac deg

138
Q

dx dry mac degen

A

drusens on retina, changes in pigmentation

139
Q

dx wet mac degen

A

fluid/hemorrhage under retina, neovasc (fluorescein angiogram)

140
Q

tx dry mac degen

A

no smoking
vit a/c
zinc
beta carotene

141
Q

tx wet mac degen

A

vit a/c
zinc
intravitreous injection VEGF
photodynamic therapy

142
Q

collection of blood in anterior chamber

143
Q

what can a hyphen result in

A

IOP and vision loss

144
Q

path of blunt trauma causing hyphema

A

force on eye immed inc IOP creates tears in blood vessels but bleeding stops quickly
rebreeding can occur 2-3 days later from disruption of clot

145
Q

path penetrating trauma causing hyphema

A

traumatic disruption of vasculature causing bleeding

146
Q

path spont hyphema

A

neovasc ant cham-dm
clotting disorders
platelet inhib/anticoag

147
Q

pt presents with blood layer, photophobia, unequal pupils, and dec visual acuity

148
Q

tx hyphema

A 
consult ophth
eye shield 1w
bed rest
head 30 deg
pain control/cycloplegia (cyclopentolate)
149
Q

causes of orbit fracture

A 
motor vehicle creash
assault
sports
intracranial injury
intraocular injury
150
Q

types of orbit fractures

A

orbital zygomatic
nasoethmoid
orbital floor
orbital roof

151
Q

most common orbital rim fracture due to high impact blow

A

orbital zygomatic fracture

152
Q

medial orbital rim w maxillary bone fracture and lacrimal disruption

A

nasoethmoid fracture

153
Q

“blowout fracture” from baseball hitting eye, can cause entrapment inferior rectus muscle

A

orbital floor fracture

154
Q

fracture common kids

A

orbital roof fracture

155
Q

when should ct be done with fractures

A

obvious fracture noted
dec EOMs
severe pain
difficult/incomplete exam

156
Q

how long may pt have diplopia w fractures

157
Q

vitreous traction on retina causing retina to separate from epith and choroid

A

active retinal detachment

158
Q

fluid accum betw retina and underlying epith

A

passive retinal detachment

159
Q

what does separation of retina from underlying layers lead to

A

ischemia of neurons- degeneration of photorec=vision loss

160
Q

mc retinal detachment with hole/tear in retina

A

rhegmatogenous retinal detach

161
Q

what causes rhegmatogenous retinal detachment

A

vitreous traction- humor adheres to retine- contracts-pulls retina-tears
fluid/humor leaks accum behind retina causing detachment

162
Q

vitreous traction is nonrhegmatogenous retinal detachment

A

like rhegmato but pulls retina off instead of tearing it

163
Q

exudative detach of retina

A

partial thickness retinal detach from inflam/malignant process

164
Q

lattice degeneration of retinal detach

A

atrophy of retinal tissue- prone to vitreous traction

165
Q

rf of retinal detachment

A

myopia (nearsightedness)
cataract surgery
age
fam hx

166
Q

pt presents with floaters, black spots, and flashes of light and on exam see curtain

A

retinal detachment

167
Q

tx vitreous traction retinal detachment

A

observ- floaters resolve 3-12m may be persistent

sump get worse=vitrectomy

168
Q

tx retinal hole/tear wout detach

A

laser retinopexy/ cryoreinopexy

169
Q

tx hole/tear w retinal detach

A

laser retinopexy/cryortinopexy
pneumatic retinopexy
scleral buckle

170
Q

primary cause of impaired vision in 25-74yo

A

diabetic retinopathy

171
Q

2 types diabetic retinopathy

A

nonproliferative

proliferative

172
Q

pt presents w never fiber infarcts (cotton wool spots), intraretinal hemorrhage, hard exudates, microvasc abn

A

nonprolif diabetic retinopathy

173
Q

pt presents neovasc arising from disc/retinal vessels

A

prolif diabetic retinopathy

174
Q

multifactoral causes diabetic retinopathy

A 
chronic hyperglycemia
retinal microthrombosis
growth factor
genetics
ethnic (aa, hispanics)
meds (rosiglitazone)
nephropathy (albuminuria)
175
Q

prevention diabetic retinopathy

176
Q

what retinal arteries does arterial occlusion effect

A

central and branch

177
Q

what retinal veins/ veins does venous occlusion effect

A

central/branch

hemiretina

178
Q

path arterial occlusion causing retinal vascularization

A

atheroschlerosis
cardiogenic embolism
giant cell arteritis
hypercoag

179
Q

path venous occlusion causing retinal vasc

A

compression vessels

thrombosis

180
Q

pt presents acute, painless vision loss one eye w afferent pupillary defect

A

arterial occlusion retinal vasc

181
Q

pt presents with retinal whitening and cherry red spots on macula

A

arterial occlusion retinal vasc

182
Q

pt presents gradual dec visual acuity, macular edema, and neovasc confirmed by fluorescein angiogram

A

venous occlusion retinal vasc

183
Q

tx arterial retinal occlusion

A

emergency vasc surg/ophth

conser therapy- ocular massage, reduce IOP, vasodilator meds, hyperbaric therapy, ant chamber paracentesis

184
Q

tx venous retinal occlusion

A

intravitreal anti VEGF
laser phototherapy
intravitreal steroid injections

Eye (1 decks)

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