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CSI > eye > Flashcards

eye Flashcards

1
Q

roof of orbit

A

frontalsphenoid (lesser)

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2
Q

lateral wall of orbit

A

zygomaticsphenoid (greater)

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3
Q

floor of orbit

A

zygomatic maxillarypalatine”zip my pants”

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4
Q

medial wall of orbit

A

sphenoid (lesser) maxillaryethmoidlacrimal”use medial wall to SMEL”

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5
Q

blepharitis

A

common, hypersn. rxn to staph toxins, not true infectionsymptoms: itching, burning, tearing, crusting, “greasy”

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6
Q

blepharitis tx

A

lid hygiene: WC + baby shampoo lid scrubs, OTC lid cleanersif severe: tobradex or maxitrol ointment x1wkoral doxycycline 50 mg bid x 10 days

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7
Q

chalazion

A

chronic blocking of meibomian glandssymptoms: eyelid lump, swelling, tenderness

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8
Q

hordeolum

A

acute blocking of meibomian glandssymptoms: eyelid lump, swelling, tenderness

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9
Q

tx of chalazion/hordeolum

A

WC + Abx/steroid ointmentTHEN oral doxycycline 50 mg bidTHEN steroid injectionsTHEN incision and curettage

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10
Q

molluscum

A

uncommon, papovaviruschronic follicular conjunctivitispersists until all lesions are removed–> if multiple lesions present and don’t go away–>consider immuncomp–>HIV test

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11
Q

molluscum tx

A

incision and curettagecryotherapychemical ablatives

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12
Q

preseptal cellulitis

A

commonsymps: tenderness, red eyelid, mild feversigns: eyelid erythema, edema, warmth tenderness, conjunc. chemosis, eyelid skin tightness, eyelid lymphedema (fluctuant)

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13
Q

preseptal cellulitis etiology

A

trauma (puncture, insect bite)adjacent infectionS. aureus, Strep, H. flu, HSV, VZV

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14
Q

ddx: preseptal vs. orbital cellulitis: orbital if..

A

hx of sinus infEOM restrictionAPD, proptosis, pain with eye movementother tests: CT of brain/orbits, CBC w/diff, Gram stain&culture

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15
Q

mild preseptal cellulitis tx

A

augmentin 500 mg PO tid x10 days(PCN allerg): bactrim DS x10 days

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16
Q

mod-severe preseptal cellulitis tx OR

A

IV Unasyn or Ceftriaxone(PCN allerg): IV Moxifloxin or Vancomycin x 10-14 days*IV–>PO if improvement

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17
Q

if secondary conjunctivitis present with preseptal cellulitis, tx w/

A

erythromycin ointment

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18
Q

if abscess present with preseptal cellulitis

A

I + D and Cx/Gs

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19
Q

make sure to do this with preseptal cellulitis tx

A

daily follow-up until improve

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20
Q

orbital cellulitis symptoms

A

uncommonred eye, pain, double/blurred vision, headache, diplopia

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21
Q

orbital cellulitis signs

A

eyelid edema, erythema, warmth, tenderness, conjunc. chemosis, optic disc edema, purulent discharge, fever, *proptosis, restricted ocular motility w/ pain on attem. mvmnt, +/- APD

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22
Q

orbital cellulitis etiology

A

extension of sinusitis (ethmoiditis)orbital/dental fracturevascular extension from bacteremia/facial cellulitis

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23
Q

orbital cellulitis organisms

A

adult: Staph and Strepchildren: Haemophilusdental abscess: mixed aerobes and anaerobesimmunecomps: fungi (mucor, aspergillus)

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24
Q

orbital cellulitis work-up

A

CBC and blood Cxhead/orbit CTGs and CxLP if ment stat and pn w/ nk flexion (mening)

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25
Q

orbital cellulitis tx

A

admit for IV Abxadults: vanco + Unasyn or Zosyn(PCN allerg): Vanco + Cipro + metronasal decongestant

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26
Q

if optic neuropathy suspected/severe proptosis suspected with orbital cellulitis…

A

perform a canthotomy/cantholysis –>relieves eyelid “compartment syndrome”

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27
Q

orbital cellulitis assessment

A

daily pupil, Va, motility, IOP, WBC–>change to oral Abx if improving (augmentin, bacterim)

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28
Q

if orbital cellulitis not improving with 48-72 hrs of IV..

A

re-image to look for abcess, surgical drainage

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29
Q

orbital pseudotumor AKA idiopathic orbital inflammatory disease (IOID)

A

acute onset of pain, red eye, proptosis, diplopia, blurred vision, typ. unilateral in adults, bilat. in kids w/ assoc. fever, malaise

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30
Q

if IOID bilat in adult need to rule out..

A

systemic disease: Saroid, Wegners, breast Ca metastasis

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31
Q

CT scan of IOID

A

thickened mm., tendons, and posterior sclera (“ring sign”)–>helps ddx from orbital cellulitis or TED(thyroid orbitopathy): only mm. involved

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32
Q

if uncertain it’s IOID + no response to steroids

A

biopsy

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33
Q

IOID (orbital pseudotumor) tx

A

60-100mg prednisone w/ PPI (GI prophylaxix), slow taper**do not want to give orb. cellulitis pts steroids!!

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34
Q

canaliculitis

A

canaliculi inf.tearing, expressible discharge, erythema, recurrent conjunctivitis, “pouting punctum”

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35
Q

canaliculitis organisms

A

actinomyces isrealii (MC?)Nocardia, Candida, Fusarium, Asp*take smear and Cx of discharge, Gram and Giemsa stain

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36
Q

Canaliculitis tx

A

topical ciprofloxacin and oral doxycycline x2 weeksWC + probing and irrigation w/ PCN + iodine 1%canalicular curettageI&Dif fungus: nystatin drops

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37
Q

dacryocystitis organisms

A

staph & streppseudomonasH. flu

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38
Q

dacryocystitis tx

A

WC + topical and PO AbxI&D if abscessavoid probing and irrigation during acute phase

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39
Q

dacryocystitis tx after acute inflammation controlled

A

dacryocystorhinostomy(DCR) crack bone, thread lacrimal system…

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40
Q

dacryoadenitis

A

rare inf. of lacrimal glandpain, redness, swelling over outer 1/3 of upper lidtyp. seen in kids

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41
Q

dacryoadenitis etiology

A

inflammatory conditions (most common), bacterial (staph, strep, Neisseria), viral (mumps, mono, Herpes Zoster)

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42
Q

dacryoadenitis tx (aimed at etiology)

A

if unclear or bac: Abx FIRST: Augmentin or Keflex inflam: Medrol dose pack or systemic steroidsviral: symptomatic relief

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43
Q

if dacryoadenitis tx is not responding: rule out..

A

lacrimal gland mass

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44
Q

conjunctivitis

A

red eye, discharge (worse in am) itching, FBS?hx of recent URI

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45
Q

forms of conjunctivitis

A

viral, allergic, atopic/vernal, bacterial, gonococcal

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46
Q

2 types of conjunctivitis

A

follicularpapillary

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47
Q

follicular conjunctivitis

A

follicles- small dome shaped nodules w/out prominent central vesseletiology: virus, bac, chlamydia, toxins-represents aggr. of lymphos and plasma cells in superficial stroma btw tarsus and conjunctiva-may have germinal centers or macrophages

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48
Q

papillary conjunctivitis

A

papillae- cobblestone arrang. of flattened nodules w/ vascular core-beefy red, in young kidsetiology: allergic/atopic (watery discharge), vernal/limbal (horner trantas dots), gonococcus (sev. purulent discharge), bacterial (scant discharge)-nodules of conj. epi w/ many eosins, lymphos, plasma cells w/ central vascular channel

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49
Q

viral conjunctivitis

A

adenovirus, typ. after URI+preauricular adenopathyone eye–>both eyeswatery discharge, pseudomembranes, SCH?, symblepharon?

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50
Q

viral conjunctivitis tx

A

cool compress, art. tears, +/- antihistaminesteroids drops if sub epithelial infiltrates-membrane can be manually peeled

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51
Q

viral conjunctivitis is highly contagious for how long

A

10 days from onset

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52
Q

bacterial conjunctivitis

A

follicular/papillaryetiology: staph, strep, moraxella, H. flu-Cx & Gs if purulent, persistent, or recurrent

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53
Q

bacterial conjunctivitis tx

A

ciloxan or vigamoxpolymyxin B sulfate w/ trimethoprim

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54
Q

gonococcal conjuntivitis

A

hyperacute, severe purulent discharge + LAD?

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55
Q

gonococcal conjunctivitis tx

A

IV/IM ceftriaxonetopical FQs q 1 hr if K involved?saline irrigation until discharge resolvescover for chlamydia as well: azythromycin x 1 or doxycycline x 1 wk

56
Q

allergic conjunctivitis

A

pediatric red eye, itchy/scratchy, +/- lid involvement, +/- seasonal, typ. both eyes, hx of allergies, absence of URI, no nodes, papillae present-common: young boys w/ eczema–>vernal

57
Q

allergic conjunctivitis tx

A

elim. inciting agentcool compress + art. tearsoptivar (mast cell stabilizer) +/- antihistaminetopical steroid if severeif vernal: topical cyclosporine + steroid

58
Q

subconjunctival hemorrhage

A

typ. asymptomatic, clears in 1-2 wks, no tx needed causes: valsalva, trauma, HTN, bleeding d/o, idiopathic

59
Q

if subconjunctival hemorrhage is recurrent

A

work up: bleeding time, PT, PTT, INR, CBC (leukemia), Protein C and S

60
Q

pterygium and pingueculum

A

due to prolonged sun exposure-elastotic degeneration of conjunctivatx: symptomatic: acular + art. tears, resection of affecting /, vision, cosmesis?, recurrent inflammation

61
Q

keratitis/ulcer

A

redness, pain, photophobia, dec. vision-focal white opacity (infiltrate) in corneal stroma, dendritic keratitis

62
Q

keratitis/ulcer etiology

A

bacterial: most common, assumefungal: organic matter trauma, chr. eye diseaseacanthamoeba: extreme pain, contacts +/- poor hygiene +/- swimmingHSV: unilat, eyelid rash, prev. episodes, nodes, dendritesatyp. mycobacteria: prev. ocular surgery/grafts, indolent course

63
Q

keratitis/ulcer dx

A

corneal scraping for smears & cx:-if suspect unusual org. from hx and presentation, > 2mm / in visual axis, if unrespons. to tx

64
Q

keratitis/ulcer tx

A

cycloplegicstopical abx according to size, zymar, vigamox, fort. tobramycin/gentamycin + fort. cefazolin/vancooral abx: ciprofloxin, impending perforation

65
Q

fungal keratitis/ulcer

A

NAME?

66
Q

acanthamoeba

A

severe pain, contacts w/ poor cleaning/swimmingdx: confocal microscopy, cx on nonnutr agar w/ E. colitx: polyhexamethyl biguanide + brolene + neosporin (essen. pool cleaner!)

67
Q

PS response causes..

A

ciliary musc to contract–>zonules relax–>inc. AP diameter and diopteric power of lens–>refracts light (accommodation)

68
Q

total refractory power of lens ? from air-tear interface ?from lens ?

A

60 D40 D from interface15-20 from lens

69
Q

cataract

A

compression and hardening of lens, change in lens proteins cause change in refractive index, scatter, and red. transparency

70
Q

nuclear sclerotic cataract

A

“aging”, compr/harden. of lens nuc as new layers of cortical fibers formedimpairs distance more than near vision, second sight (AP growth)

71
Q

posterior subcapsular cataract

A

“fish eggs” dec. vision in bright lights (glare), obscured when mitosis/constricted,impairs near more than distant vision

72
Q

cortical cataract

A

“spokes on a wheel” worse when eyes dilated/mydriasis, glare and halos around lights

73
Q

indications for cataract surgery

A

NAME?

74
Q

phacoemulsification

A

(1967, Kelman)small incision made in cornea (no stitches req.)–>US probe inserted into A/C and used to break up cataract–>aspiration of lens–>insertion of pre-measured intraocular lens

75
Q

iritis

A

photophobia, redness (perilimbal) dec. visioncauses: trauma, vasculitides (HLA-B27, TB, JRA in kids, sarcoid in AA’s)flare in ant. chamber, keratic precipitates- KP, band keratopathy, synecheia, if no hx trauma, do vasculitis w/u

76
Q

vasculitis w/u for iritis

A

CBC, ESR, ANA, PPD, RF, ACE, lysozyme, RPR/FTA-abx, CANCA, HLA-B27

77
Q

iritis tx

A

cycloplege (dilate to keep from scarring), pred forte?q1-6oral prednisoneimmunosuppressives

78
Q

endophthalmitis

A

dec. vision and painabsent red reflex, vitrifies, hypopyon (eye filled with WBCs), conj. injection

79
Q

endophthalmitis types

A

-postoperative (acute: S. epi, S. aureus, strep, pseudomonas; chronic: p. acnes)-traumatic (same ^ + bacillus)-endogenous (endocard, IV feeding, immsupp, brspec abx)–>cx everything (blood, urine, catheters, IV line)

80
Q

endophthalmitis tx

A

postop: VA? , tap and inject (cx, smears) intravitreal vanco + amikacin +/- dexa-topical fort. abx + steroidsconsider PO/IV FQstrauma: same ^, tetanus toxoidendogenous: brdspec IV abx (ID consult)aminoglycoside + clindamycin in IV drug users intravitreal vanco + amikacin

81
Q

aqueous humor production

A

produced by ciliary bodies in post. chamber–>around pupillary margin into ant. chamber–>drained through trabecular meshwork

82
Q

glaucoma

A

grp of diseases: optic neuropathy, assoc. with visual field loss, increased intra ocular pressure is a risk factor, not requirementcup: disc ratio around 0.8 (vs. 0.4) due to atrophylook for patholitis (swelling of optic n., irreg. borders)

83
Q

types of glaucoma

A

-open angle: abnorm. that clogs it up–>inc. pressure–>optic neuropathy-angle closure w/ pupillary block: iris buds against ant. lens, AH build up in post chamber–>^^pressure–>vomiting, ha-angle closure w/out pupillary block: something from cornea into iris and pulling it up

84
Q

indications for glaucoma surgery

A

progressive glaucomatous optic neuropathy (GON) or visual field changes on MTMTfailed IOP control after laster txintolerance/noncompl to medsgoal of filtering surgery: create pathway for AH to flow from ant chamber thru sclera into subconj and subtenons space

85
Q

types of glaucoma surgery

A

trabeculectomy w/ MMC: partial thickness scleral flap allows for controlled filtering of AH form ant cham into subconj space–>conj. bleb formedtub implant: inserted into ant chamber thru sclera, allows for flow of AH from ant chamb into plate at subconjunc space

86
Q

age related macular degeneration

A

most common cause of dec. VA in USsymp: metamorphosis (waviness) w/ loss of central vision

87
Q

dry macular degeneration

A

most common (80%) drusen: yellow EC deposits btw Bruchs and RPE? RPE atrophy: photorec.loss

88
Q

dry mac deg tx

A

AREDS (vitamin C, E, beta carotene? (now omega 3s), zinc, copper)

89
Q

wet macular degeneration

A

exudative, break in Bruch’s membrane–>neovasc/bleeding

90
Q

wet mac deg tx

A

intravitreal anti-VEGF agents +/- laser

91
Q

diabetic retinopathy

A

retinal damage due to chronic hyperglycemia- implies other organs are affectednonprolif: mild or modif severe (4:2:1 rule): 4 quads of diffuse intraret heme and micro aneurysms, 2 quads venous beading, 1 quad IRMAclin. sig macular edema: w/in 500 um fovea, hard exudates w/ adj. edema, edema 1 disc area w/in 1 disc diam. of fovea

92
Q

proliferative diabetic retinopathy

A

any NVD w/ VH, 1/4-!/3 disc area NVD1/2 disc area NVE w/ VH

93
Q

diabetic retinopathy tx

A

laser, intravitreal anti-VEGF injections

94
Q

classic visual field loss

A

bitemporal heminopsia

95
Q

causes of chiasmal defects

A

pit tumor, sheehan’s, pit apoplexy, craniopharyngioma, meningioma, glioma

96
Q

distance chiasm lies above pit gland

A

1 cm

97
Q

micro vs macroadenoma

A

micro presents to endocrinologist, macro presents w/ VF changes?

98
Q

optic neuritis

A

inflame of optic n.symps: central visual loss, pain with eye mvmnt, APD w/ dec. color vision (red)

99
Q

optic neuritis ddx

A

viral, MS, vasculitis (SLE) granulomatous (syph, sarcoid) idiopathic

100
Q

optic neuritis w/u

A

MRI w. flairatyp >1 mo: ANA, anti-DNA, VDRL, RTA-ABS, CXR, ACE, ESR

101
Q

optic neuritis px

A

visual recovery (20/40) in 95% untr. ptsMRI: risk of MS:0 lesions 16%, 3+: 50%

102
Q

optic neuritis tx

A

do not give oral prednisone! inc. recurrenceIV methylprednisolone rec. vision faster if treated w/in 1st 2 wks but no effect on recurrences

103
Q

MS

A

autoimmune attack of myelin causing inflame. demyel. of CNS F>M (2:1)dx: 2 attacks sep by > 1 mo in sep parts of CNS-episodes last wks-mos: diplopia, ataxia, vertigo, parethesias, bladder/bowel dysfunction, extrem. wkness, e- shock-like sens.

104
Q

eye findings w/ MS

A

optic neuritis (75%), diplopia, internuclear ophthalmoplegia (INO)

105
Q

MS lab tests

A

MRI w. flair, periventr. plaquesspinal fluid: elevated IgG, oligoclonal bands

106
Q

MS tx:

A

ABC: Avonex, Betaseron (interferon B), Copaxone

107
Q

MS disease course

A

primary progressive (10%) from onsetsecondary prog. (50%): relapsing/remitting w. slow continuous deteriorationbenign (30%): no serious disability

108
Q

CN III nucleus

A

in midbrain, level of sup. colliculusmultiple nucleii: -single central located nuc: both levators-paired SR nuc that cross to supply C/L SR-paired nuc that do not cross: supply MR, IR, IO-Edinger-Wesphal nuc supplies PNS input to both eyes

109
Q

CN III fascicle syndromes

A

ischemic, infiltrate or inflamm. conditionsaffects fascicles–> I/L CN III paresis + other mdbn structures

110
Q

CN III: Nothnagel’s

A

superior cerebellar peduncle, leads to I/L CN III paresis + cerebellar ataxia

111
Q

CN III fascicle:

A

travels ventrally traversing red nuc and corticospinal tract

112
Q

CN III: Benedikt’s

A

-red nuc, leads to I/L CN III paresis + C/L tremor + C/L dec sens

113
Q

CN III: Weber’s

A

pyramidal tract, leads to I/L CN III paresis + C/L hemiparesis

114
Q

CN III supplies

A

superior: SR and levatorinferior: IR, MR, IO

115
Q

PNS from E-W nuc travels w.

A

inf div of CN III

116
Q

CN IV

A

@ mdbrainfascicles: only CN that decussates and exits dorsally

117
Q

CN IV enters

A

cavernous sinus, SOF outside annulus of Zinn, inn. SO, longest intracranial course, most common CN injured w/ head trauma

118
Q

isolated CN IV palsy

A

congenital: large vert. fusion amp, head tilt in old photosacquired: vertical diplopia, chin down, head tilted away from lesion

119
Q

CN VI

A

nuc @ pons medial to CN 7, lesion–> I/L gaze palsy

120
Q

CN VI fascicles

A

travel anterolat to PPRF then thru pyramidal tract

121
Q

Brain stem syndromes:Millard-Gublar

A

CN 6, 7, + pyramidal tractI/L CN 6, 7 palsies, and C/L paresis

122
Q

brain stem syndromes:Foville’s

A

CN 5, 6, 7, +SNS I/L CN 5,6,7, palsieshorizontal conjugate gaze palsy

123
Q

brain stem syndromes: Raymond’s

A

CN 6 + pyramidal tractI/L CN 6 palsy + C/L paresis

124
Q

CN VI nerve exits..

A

lower pons, climbs over clivus and petrous ridge, vuln. to inc. ICP, common CN palsy affected in pseudo tumor cerebri (30%)travels along base of skull thru Dorello’s canal under Gruber’s ligament–>enters cavernous sinus closest to ICA and SNS (only place to get isolated CN 6 palsy + Horner’s)-enters SOF, innervates LR

125
Q

CN VI: Gradenigo’s syndrome

A

mastoiditis of petrous apex following otitis media-CN 6 palsy + I/L dec. hearing + facial pain and paralysis

126
Q

Pons lesion: INO

A

lesion in MLF, due to MS or stroke: CN VI stim. I/L LR but C/L CN III cannot stim. MR:adduction deficit (I/L) abducting nystagmus (C/L)

127
Q

Pons lesion: One and a half syndrome

A

lesion of MLF and ipsilat CN VI nuc:ipsilat add. deficit, ipsilat conj. gaze paresis, *only movement is contralat abduction

128
Q

cavernous sinus thrombosis

A

blood clot of ICA from spread of infection of sinuses-ptosis, chemosis, CN 3, 4, 5, 6 palsies

129
Q

PNS: pupillary light reflex miosis

A

optic nerve–>chiasm–>optic tract–>pretectal nuc (synapse), cross to both EW nuclei (synapse), travel via CN III–>ciliary ganglion–>postgang fibers via short ciliary nerves to ciliary body and iris sphincter: constriction

130
Q

APD/Marcus Gunn Pupil

A

any damage to ON from retina to pretectal nuc.-swinging flashlight test: pupil dilates

131
Q

CN 3 palsy”blown pupil”, usually ptosis and dec. EOMsetiology: aneurysm,: posterior communicating artery, tumor, vascular

A

“blown pupil”, usually ptosis and dec. EOMsetiology: aneurysm,: posterior communicating artery, tumor, vascular

132
Q

Adie’s tonic pupil

A

-middle age women (70%)dysfunc. of PNS at ciliary ganglionpost-viral or post orb sympts. mydriasis, more in lightsluggish, segmental pupillary response (vermiform)light-near dissociationdiminished deep tendon reflexessuper sensitive to pilo 0.1%

133
Q

SNS: pupillary light reflex, mydriasis

A

1st order neuron: hypothalamus to T1 level of SC2nd order neuron: SC to C2 level of sup. cerv. ganglion (symp)3rd order neuron: cervical gang. through ciliary ganglion to nasociliary and short ciliary nn., follows carotid artery

134
Q

SNS disorders: PLR, Horner syndrome

A

PAM:ptosis (Muller’s musc)anhydrosis (always if 1st-order involved)miosis (greater in dark)-iris heterochromia (congen)pain: dissecting carotid aneurysm (3rd order)

135
Q

Horner syndrome w/u

A

apraclonidione: if pupil dilates: Hornersthen hydroxyamphetamine: pupil dilates: 1st/2nd orderno dilation: 3rd orderMRI of head (cavernous sinus), neck, lung apices

CSI (75 decks)

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