EYE

Question 1

Acute ONSET Redness and Tearing of EYE. Sensation for Foreign Body with NO significant Pain, Just Mild Irritation. Injection of sclera and conjunctiva (Appears Bright Red).

If it reoccurs there is a concern for IBD or RA.

Dx?
Rx?

Answer 1

Episcleritis

Self limited no treatment

Topical Lubricants or NSAIDS can help

Question 2

Pt presents with Painful, Red Eye and Photophobia. Eye shows a Ciliary flush and White pus on eye.

Dx?
Rx?

Answer 2

Anterior Uveitis. (Iritis.)

Topical Steroids

Question 3

Conjunctivitis associated with herpes zoster rash involving ophthalmic division of the fish cranial nerve?

Dx?
Rx?

Answer 3

Herpes Zoster Conjunctivitis.

Emergent Optho referral

Question 4

Acute hyper-purulent discharge in sexually active adult.

Dx?
Rx?

Answer 4

Neisseria Gonorrhoeae Conjunctivitis.

Topical and systemic abx, emergent Optho referral

Question 5

Unilateral then bilateral conjunctivitis with daytime watery or mucoid discharge

Answer 5

Viral Conjunctivitis

Supportive care

Question 6

Itching and tearing of the eyes, nasal congestion

Answer 6

Allergic conjunctivitis

Question 7

Pain, Photophobia, Inflammation confined to Corneal Limbus, Corneal Irregularity.

Dx?
What is it associated with?
Rx?

Answer 7

Iridocyclitis or keratitis.

Associated with Sarcoid, Sponylarthropathies HLAb27 (Ankylosing Spondylitis, IBD, Psoriatic Athritis, Systemic Sclerosis)

Emergent Optho referral

Question 8

Unilateral Deep Ocular Pain, NAUSEA, VOMMITTING, fixed FIXED NON REACTIVE PUPIL, shallow anterior chamber in an OLD PERSON.

Answer 8

Acute Angle Closure Glaucoma

Question 9

Severe Ocular PAIN that worsens with eye movement and light exposure, a raise hyperemic lesion (DARK RED SCLERA) that may be localized or diffuse and obscures the underlying vasculature. Dx? Rx?

Answer 9

Scleritis

Emergent Optho Referral

Topical and IV Steroids and Immunosuppressants

Question 10

Red eye with scales and crust around the eyelash or dandruff-like skin changes and greasy scale around the eyelashes.

Answer 10

Blepharitis

Warm compress, Wash with mild soap, Topical abx

Question 11

Unilateral then bilateral purulent discharge without pain or visual disturbance

Answer 11

Bacterial conjunctivitis

Topical fluoroquinolone or bacitracin-polymyxin

Question 12

Occurs in ages > 60. Painless Acute Vision Loss in one eye, Fundoscopy shows retinal whitening with a cherry red macular. Amaurosis Fugax Precedes Vision Loss.

Dx?
Rx?

Answer 12

Central Retinal Artery Occlusion. CRAO

Urgent eye referral to lower pressure

(Ocular massage, IV Acetazolamide or Mannitol)

Question 13

Occurs in ages > 60 Painless vision loss in one eye, with evidence of papilledema

Answer 13

NonArteritic Anterior Ischemic Optic Neuropathy

Question 14

Occurs in ages < 50. Painful vision loss in one eye, color desaturation, HA and pain with eye movement. White matter lesions seen on MRI. Dx? Rx?

Answer 14

Optic Neuritis. Common associated with MS. IV methylprednisolone.

Question 15

Patinet complains of Vision loss and Floaters.

It is associated with Trauma or Previous Eye Surgery.

Dx?

Who does this happen to in Non-Traumatic Cases ?

Answer 15

1. Retinal detachment
2. Patients with Non-traumatic Proliferative Diabetic Retinopathy

Question 16

Pt wears Contact Lens then develops pain, Swelling, Photophobia, Conjunctival injection. Epithelial Ulceration Seen. Dx? Tx?

Answer 16

Bacterial Keratitis

Optho Referral

Broad-Spectrum Topical Abx (Gatifloxacin - to cover pseudomonas.)

Question 17

Foreign body sensation of Eye. Dx?

Answer 17

Corneal Ulcer

Question 18

Older many presents with Intermittent Blurry vision, Feels like a Curtain is falling in front of his eye, Headaches, Decreased Appetite, Difficulty eating solid foods due to Pain While Chewing. There is no scalp tenderness. ESR 50.
Dx?
Test?
Rx?
Wha else is recommended?

Answer 18

Giant Cell Arteritis. (Presents with Amaurosis Fugax)

Temporal Biopsy

IV Steroids

Baby Aspirin also recommended to Decrease risk of Stroke.

Question 19

Older Patient presents with Gradual Painless Vision Loss. Difficulty driving at night. There is Evidence of Mottling of Sub-Retinal Pigments and Bright Yellow Drusen Deposits in the macular area.
Dx?
Rx?

Answer 19

1. Dry Age Related Macular Degeneration
2. Smoking Cessation Counseling

Question 20

Gradual Pain loss of Vision.
Fundoscopy Shows Increased Optic Cup Size and Cup to Disk Ration.
Tonometry shows Elevated Intraocular Pressure.

Dx?

Answer 20

Open Angle Glaucoma