Eye Flashcards
Name the risk factors for Open Angle Glaucoma
African americans
DM
Fx Hx of Glaucoma
How Open angle Glaucoma presents?
Gradual loss vision start from periphery
Increase IOP on tonometry
Fundoscopy findings–> Enlarged Optic cup and cupping of the disc
What are t/m options of Open angle glaucoma?
first line–> topical prostaglandins–>increases drainage of aqeuous humor via Uvealsacral pathway
2nd line–> BB
Laser tabeculoplasty
Important point of Open angle glaucoma
Avoid to use steriods as it decreases outflow of aqeuous humor from anterior chamber
How steroid causing Open angle glaucoma?
decrease drainage of aqueous fluid leads to increase IOP–> Open angle glaucoma
corneal edema leads to central blurriness
How close angle glaucoma presents?
seen in old age with headache and nausea
Red,painful eye and blurred vision
Pupil is fixed and mid-dilated without ulceration
Important point of close angle glaucoma
Avoid to use pupil dilating medication or sitting in dark place as it will lead to pupil dilation
How to dx Close angle glaucoma?
Gold standard–> gonioscopy
Also tonometry
How to t/m closed angle glaucoma?
IV acetazolamide and Pressure lowering eye drops
definitive laser iridotomy
D/f b/w in terms of pupil of uveitis / close angle glaucoma / conjunctivitis
Uveitis: pupil is constricted with a poor light response
close angle glaucoma:: pupil is dilate with a poor light response
conjunctivitis:: size and response to light are normal without affecting visual acuity
Fundoscopy findings of DM retinopathy
Microaneurysm and Hard exudates
Retinal Hx and sometimes neovascularisation
How fundoscopy findings of DM retinopathy from Open angle glaucoma?
DM retinopathy::
Disc is normal
and Visual field defects are patchy
Open angle Glaucoma::
Cupping of disc
and visual field defects starts from peripheral
Fundoscopy findings of HTN retinopathy::
AV nicking and copper wiring
flames hx and cotton wool spots
optic disc edema
How Aged related macular degeneration d/f from DM retinopathy?
In Age related macular degeneration, gradual loss of cental vision
Fundoscopy findings of AGMR
Subretinal drusen and pigment anomalies
How Nor-arteritic anterior ischemic optic neuropathy d/f from DM retinopathy?
Nor-arteritic anterior ischemic optic neuropathy:::
Painless mono-ocular vision loss
Optic disc edema and afferent pupillary defect
Triad of Optic neuritis
acute mono-ocular vision loss
Pain with extra ocular movement
U/L optic disc edema
Name the medicines for glaucoma
Trabecular outflow:: muscarinic agonists
Uveoscleral Outflow:: Prostaglandin Agonists
Aqueous humor inflow:: BB / Alpha agonist / carbonic anhydrase inhibitors
What is dacryocystitis?
Infection of the lacrimal sac with inflammatory changes in the medial canthal region of eye.
Name the bacteria of causing dacryocystitis
S.aureus
B-Hemolytic strept
How dacryocystitis presents?
Seen in infants and adults over age 40yrs
sudden onset pain with edema
redness in medial canthal region
Purulent discharge from punctum
What is episcleritis?
Inflammation or infection of the episcleral tissue between the conjunctiva and sclera
or inflammation of white of the eye w/o involvement of uveal tract
How episcleritis presents?
Sudden onset pain with photophobia
Watery discharge without affect vision or cornea
Diffuse or focal bulbar conjunctival injection
What is hordeolum?
abscess of the eyelid due to Staph.aureus
How external hordeolum (stye) presents?
erythematous tender nodule at the lid margin
How to t/m external hordeolum(stye)?
warm compresses if persistent(>1-2wks), incision and curettage
How internal hordeolum presents?
Involvement of meibomian gland
tender nodule visible at the palpebral conjunctiva
How chalazion presents?
Granulomatous inflammation of meibomian gland presents hard painless lid nodule
Triad of Orbital cellulitis
Sudden onset fever proptosis
Restriction of Extra ocular movement is restricted
Eyelids are red and edema
How herpes zoster ophthalmicus presents?
Dendriform corneal ulcer and conjunctivitis
vesicular rash in V1 region of trigeminal area
Burning and itching sensation in the periorbital region
Name the condition which show hutchinson signs?
herpes zoster ophthalmicus
How herpes simplex keratitis presents?
Dendritic corneal ulcer and vesicles
Pain with photophobia and decreased vision
Minor clear vesicles in the corneal epithelium
How to t/m conjunctivitis due to adenovirus?
Cool/warm and moist compresses
with or without antihistamine/ decongestant drops
How to t/m conjunctivitis due to bacteria?
if contact lens wearer: quinolone drops
Erythromycin ointments
polymyxin-trimethoprim drops
azomax drops
How to t/m conjunctivitis due to allergic?
antihistamine/ decongestant drops for intermittent SxS
antihistamine/mast cell stabilizer for frequent episodes
Differentiation d/f causes of conjunctivitis
Allergic::
B/L involve with watery scant discharge and itch
Stuck shut of eye with no reappearance of discharge after wiping
Bacterial::
B/L or U/L involve with purulent thick unremitting discharge
Stuck shut of eye with reappearance of discharge after wiping
Viral::
B/L involve with watery scant discharge and burning/gritty
Stuck shut of eye with no reappearance of discharge after wiping
Findings of bacterial conjunctivitis Vs
viral conjunctivitis Vs allergic conjunctivitis
bacterial conjunctivitis
Diffuse non follicular injection
viral conjunctivitis
Diffuse bumpy / follicular injection
allergic conjunctivitis
Diffuse bumpy / follicular injection
conjunctival edema (chemosis)
How endophthalmitis presents?
Conjunctival irritation
Purulent haziness of the ocular content
Layering out of pus in the anterior chamber (Hypopyon)
Whom is more prone to develop bacterial keratitis?
Contact lens wearers
Triad of Subconjunctival Hx
Local trauma / cough, sneezing, vomiting
well demarcated patch of extravasted blood beneath the conjunctiva
Require no t/m as benign condition
How retinal detachment presents?
seen in 40-70yrs with Underlying trigger
happened before condition occur
sudden onset Photopsia and floaters
Ophtho findings show grey elevated retina with fold and /or a tear
Name the condition in which patient says curtain coming down over the eyes
Retinal detachment
amaurosis fugax
Name the condition which causes retinal attachment
severe myopia / DM retinopathy
Hx of eye surgery or trauma
How to managed Retinal detachment?
laser therapy and cryotherapy to create permanent adhesions b/w neurosensory retina, retinal pigment epithelium and choroid
Triad of Choroidal rupture
blurred vision following ‘‘blunt trauma” (cause of it)
crescent shaped streak concentric to the optic nerve
central scotoma with hx detachment of the macula
Fundoscopy findings of CRAO
sudden onset loss of vision
pallor of the optic disc with cherry red fovea
Boxcar segmentation of blood in the retinal veins
Fundoscopy findings of CRVO
blood and thunder appearance
Disk swelling with venous dilation
tortous retinal Hx
cotton wool spots
Name the risk factors for CRVO
Factors which increases coagulopathy / glaucoma / atherosclerotic risk factors
How to confirm CRVO and t/m?
Fluorescein angiography
if macular edema–> Intravitreal injection of VEGF inhibitors
if no macular edema or neovascularisation–>managed conservatively with close observation
What is the mcc of vitreous hx?
DM
triad of Vitreous hx presents
Sudden onset loss of vision and onset of floaters
d/f to visualise the fundus
stat consultation otherwise do upright position during sleep
Triad Age related macular degeneration
seen in over 50 yrs old patient
B/L progressive loss of central vision
Intact peripheral and navigational vision
How the ARMG patient describes the findings of Grid tests?
Vertical lines bent and wavy
D/f types of AGMR
Atrophic form–> multiple sores in the macular region
Exudative form–> newly blood vessels leak/ bleed and scar the retina
Triad of Posterior capsule opacification
Posterior capsule opacification (thickening of the capsule holding the artificial lens)
developed post-cataract surgery
Presents as cloudy vision
T/m is laser
How fungal keratitis presents?
cornea multiple stromal abscess
Fundoscopy findings of CMV retinitis
Typically painless condition
fluffy Or granular retinal lesion located near the retinal vessel/yellow white exudates and associated Hx
How to t/m CMV retinitis?
Anti virals–> valganciclovir
Intra vitreal injections–> if lesions near fovea Or optic nerve (so to avoid the blindness and retinal detachment)
How HIV retinopathy presents?
NO Floaters or blurred vision usually
Cotton wool retinal lesions which are rarely hx
How toxoplasmic chorioretinitis presents?
Eye pain & decreased vision
non vascular distribution (not perivascular)
How presbyopia presents?
affected near vision
but far vision is un-affected
How astigmatism presents?
Typically presents with blurry vision both at a distance and up close
How cataract presents?
Hx of d/f with night vision or driving at night
Name the d/f types of DM retinopathy
Simple retinopathy or Background
Pre proliferative retinopathy
proliferative or malignant retinopathy
How Simple retinopathy or Background presents?
Micro aneurysms / Hx / Exudates and retinal edema
How Pre proliferative retinopathy presents?
Cotton wool spots
How proliferative or malignant retinopathy presents?
newly form vessels
How to managed the complications of DM retinopathy?
argon laser photocoagulation
Triad of Blepharitis
b/L Burning or itching of the lids with discharge and crusting
associated with skin disorders
T/m is supportive/ warm compresses/ gentle scrubs / lid massage
Triad of Retinoblastoma
B/L if inherited and seen in less than 2yrs old
absent red light reflex
Dx is MRI of brain and eyes with no biopsy b/c of seeding
Causes of absent red light reflex
3R 1C
Retinoblastoma
CMV
Rubella
Retinopathy of prematurity
*Triad of Retinitis pigmentosa
progressive inherited night blindness
decreased visual acuity
visual field loss
Important point of Retinopathy of prematurity
retinal detachment causing loss of red reflex
seen in infant born at gestation less than 30 wks
How strabismus presents?
Asymmetric corneal light and red reflexes
eye deviation with abnormal cover test
dilated fundoscopic to dx the condition
Name the condition causing strabismus
retinoblastoma
Name the complications occur due to Myopia
retinal detachment
macular degeneration
What is Hyphema?
blood within the anterior chamber
Causes of Hyphema
if spontaneous—> due to bleeding disorder like vWD or DM
blunt trauma
what is Pterygium?
wedged shaped proliferation of conjunctival tissue that expands from the lateral of the eye
towards the cornea
occur due to UV light exposure
Triad of Retinal micro infarctions
Occur due to ischemia
associated with HTN and DM
cotton wool spots (yellow white retinal lesion) on fundoscopy
Triad of Orbital cellulitis
Painful and limited EOM
Proptosis
Dx via CT orbit and brain with IV Abs as a t/m
Name the risk factors causing Orbital cellulitis
Sinusitis
Orbital trauma
dental caries or trauma
Name the causes of neonatal conjunctivitis
Chemical
Gonococcal
Chlamydial
Triad of Chlamydial neonatal conjunctivitis
Age of onset is 5-14 days after birth
Watery/ mucopurulent/ serosangunineous discharge
T/m is PO azomax as it doesn’t cause pyloric stenosis
Triad of Gonococcal neonatal conjunctivitis
Age of onset is 2-5 days after birth
Profuse purulent discharge with eyelid edema
PPx is erythromycin ointment or t/m is IM 3rd generation cephalosporin
Triad of Chemical conjunctivitis
Age of onset is within 24 hours after birth
Due to sliver nitrate usage against gonorrhoea result conjunctival irritation and tearing
T/m is eye lubricant
How to t/m dacryostenosis (nasolacrimal duct Obs?
Messaging the duct
(It present as U/L tearing and Minimal conjunctival tearing without any eye discharge
How endophthalmitis presents?
Pain and decrease visual acuity
Occurs within 6 wks of eye surgery due to bacterial or fungal
T/m is Intra vitreal ABx injection or vitrectomy is done
How orbital compartment syndrome occur?
Swelling and hx within the confined orbital space causes rapidly increasing IOP result ischemia
of the optic nerve and globe
Triad of Orbital compartment syndrome
Acute eye pain with vision loss and limited EOM
Proptosis with peritoneal Edema and rock hard eyelid / APRD
Instant surgical decompression
How Open global injury presents?
Extrusion of vitreous and eccentric or teardrop pupil
Decrease visual acuity and IOP
RAPD
How Open global injury dx?
Fluorescein drops—-> if large injury and puncture drops may leaked from punctured site
What does gonioscopy measure?
Corneal angle
How to manage the angle closure glaucoma?
Combination multiple topical therapy given like timolol / Apraclonidine / pilocarpine
Given acetazolamide to further reduce aqueous humour
And last laser iridotomy as a definitive treatment
Triad of Strabismus
Amblyopia
Asymmetric red reflex and corneal light reflex
Tx: Patching the normal eye OR blurring the vision of the normal eye with cycloplegic drops (like atropine)
What are the Examination findigns of Strabismus and what complications would occur if untreated?
- Asymmetric Corneal light and red reflex
- Deviation of eye on covering the unaffected eye
Complication is ambylopia
How to manage Strabismus?
1) Correction of Refractive error
2) Patching Or atropine (to blur) in unaffected eye as affected get strengthen
