Eye

Question 1

Uvea

Answer 1

iris, cilia body/muscle, choroid

Question 2

Posterior chamber

Answer 2

behind the iris, in front of lens

Question 3

Conjunctivitis

Answer 3

inflammation engorges capillaries of conjunctivae –> pink/red

usually viral or allergic

u/l w/ purulent discharge - may be bacterial

Question 4

Sunconjunctival hemorrhage

Answer 4

benign

blood trapped between conjunctiva and sclera

Question 5

Scleral icteris

Answer 5

bilirubin deposits in conjunctiva –> yellow

Question 6

Arches senilis

Answer 6

white/bluish ring at periphery of cornea

accumulation of cholesterol

Question 7

Clouding of cornea

Answer 7

mucopolysaccharidoses - Hunter’s syndrome

Question 8

Corneal abrasion

Answer 8

trauma, extremely painful

Question 9

Anterior uveitis (iritis)

Answer 9

pain, redness of iris - extends into conjunctiva
photophobia
pus and inflammatory cells in anterior charger - pooling

assoc w/ reactive arthritis and ankylosing spondylitis (HLA-B27)
-sarcoidosis
Juvenile idiopathic arthritis

Question 10

Posterior uveitis

Answer 10

Less common, more infectious

CMV, toxoplasmosis, cat scratch dz

assoc w/ psoriatic arthritis and IBD - HLA-B27

Question 11

Cherry Red spot

Answer 11

central Retinal a. occlusion
Taysachs disease
Neumann-Pick dz
other lysosomal storage dz

Question 12

Frontal eye field lesion

Answer 12

-scanning eye movement impaired

eyes deviate toward lesion

Question 13

paramedian pontine reticular formation (PPRF) lesion

Answer 13

scanning eye movements impaired

eyes deviate away from lesion

Question 14

Superior colliculus lesion

Answer 14

paralysis of upward gaze - Parinaud’s syndrome

“Nerd good at Calculus, looks down”

Question 15

Retinoblastoma

Answer 15

Kids

loss of red reflex - white

Question 16

Papilledema

Answer 16

swelling of optic disc, looks fuzzy, blurry

increased intracranial pressure

Question 17

Central retinal artery occlusion

Answer 17

ischemia of eye
painless vision loss
pale retina w/ cherry red spot in macula

Question 18

Retinal detachment

Answer 18

trauma, DM

sudden onset of flashing lights and floaters

reduction of vision - permanent if not reattached timely

looks billowy, wrinkled and pale

Question 19

Diabetic retinopathy

Answer 19

Hard exudates - yellow colored spots
flame hemorrhages
cotton wool spots

Proliferative form:
proliferation of new blood vessels - neovascularization –> bleeding and scarring
tx: laser

Question 20

Macular degeneration

Answer 20

loss of central vision

Risk: smoking
Tx: antioxidants: beta-carotene, vit C, lutein, selenium, zinc

Question 21

Dry age related macular degeneration

Answer 21

drusen accumulates between retina and choroid

insidious loss of vision

Question 22

Wet age-related macular degeneration

Answer 22

rapid
neovascularization in choroid
fragile new vessels bleed and damage photoreceptors
Tx: inject anti vascular endothelial growth factor or laser therapy

Question 23

Glaucoma drugs - open angle

Answer 23

Inhibit production of aqueous humor:
Beta blockers
Carbonic anhydrase inhibitors - Acetazolamide

Improve outflow:
Prostaglandins
Alpha agonists - apraclonidine
Cholinergic agonist - pilocarpine

Laser trabeculoplasty

Question 24

Acute angle-closure glaucoma

Answer 24

lens pushes forward against iris, blocks flow of aqueous humor from posterior chamber to anterior chamber

angle between sclera and iris becomes narrower - closed angle or narrow angle

EMERGENCY!

Abrupt onset of pain, HA (temporal, eyebrow), N, colored halos, rainbows around light

Red, teary eye w/ hazy cornea and fixed, mid-dilated pupil (not reactive to light) that is firm to palpation

Tx: laser iritomy - holes in iris to allow flow

Delay of more than 1 hours to ophtho give eyedrops: timolol, apraclonidine to reduce pressure
or systemic drugs: acetazolamide or mannitol

Question 25

Open angle glaucoma

Answer 25

Tabular meshwork lost permeability

common, insidious form - usually b/l

Risk: older than 40, AA, FHx of glaucoma, myopia, and DM

Early stage: asx, elevated intraocular pressure

late: gradual loss of peripheral vision, permanent blindness if untreated

Question 26

Glaucoma screening tools

Answer 26

Tonometry - air puff

optic cup (bright center):disc ratio normal less than 50%, greater than 50% = glaucoma

Question 27

Classic presentation of cataracts

Answer 27

opacification of lens

usually b/l

slowly progressive, painless decrease in vision - difficulty driving at night, reading road signs, or reading fine print

Possible disabling glare from sunlight or oncoming headlights at night

Near-sightedness often early manifestation - “second sight” no longer need reading glasses

Risk: increased age, most common cause of blindness
long term glucocorticoid use
Tobacco
etOH
DM