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Clinical Medicine 1 > Eye Diseases > Flashcards

Eye Diseases Flashcards

1
Q

This disease is caused by the creation of a fistula between the carotid artery and the cavernous sinus creating a congestion of the orbital veins.

A

Carotid Cavernous Fistula

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2
Q

Distinguishing features is pulsatile proptosis (feeling the eye pulsate), dilated veins on the surface of the eye, and an increase in IOP

A

Carotid Cavernous Fistula

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3
Q

What does the work up include for a Carotid Cavernous Fistula?

How is it treated?

A

CT Angio

Neurosurgical Intervention

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4
Q

What are the risk factors for Carotid Cavernous Fistulas?

A

Trauma

HTN

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5
Q

This disease typically lies dormant in the trigeminal ganglion and is typically found in adults

A

Herpes Simplex

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6
Q

Herpes Simplex typically also presents with what 4 symptoms?

A

Foreign Body Sensation
Redness
Photosensitivity
Mild blurriness

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7
Q

If you suspect Herpes simplex in a patient you would preform a _____ ____ exam. What type of lesion would you be looking for on the cornea?

A

Wood’s Lamp (Flourescein)

Dendritic Lesion

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8
Q

How do you treat Herpes Simplex in the eye?

A

Topical antivirals

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9
Q

Are steroids indicated for herpes simplex?

A

Yes, but only once the infection is under control

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10
Q

This disease has skin lesions that follow a unilateral dermatome, typical the Opthalmic branch of trigeminal nerve.

A

Herpes Zoster Opthalmicus

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11
Q

Herpes Zoster Opthalmicus typically causes what three diseases?

A
  1. Conjunctivitis
  2. Keratitis
  3. Iritis
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12
Q

What are the associated symptoms of Herpes Zoster Opthalmicus?

A
  1. PAIN in the eye or skin
  2. Photosensitivity
  3. Blurred Vision
  4. Watery discharge
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13
Q

What is the most severe complication of Herpes Zoster Opthalmicus?

A

Permanent vision loss

Corneal scarring

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14
Q

This disease is typically caused traumatic bleeding, which is contained under the conjunctival layer.

A

Subconjunctival hemorrhage

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15
Q

In a patient with a subconjunctival hemorrhage, what else should you be concerned with?

A

Additional ocular injury

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16
Q

How is a subconjunctival hemorrhage treated?

A

Artificial tears for comfort

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17
Q

Do you need to stop ASA (Aspirin) in a patient with a subconjunctival hemorrhage?

A

NO

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18
Q

This COMMON disease is caused by inflammation or infection in the conjunctiva.

What are the FIVE types?

A

Bacterial, Viral, Allergic, Chemical/Toxic Kerato, and Herpetic Conjunctivitis

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19
Q

This form of conjunctivitis typically starts in one eye and spreads to the other, does not involve the lids, typically is associated with URI Sx, and is self-limited not requiring antibiotics

A

Viral conjunctivits

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20
Q

This form of conjunctivitis is typically unilateral, has mucopurulent drainage, responds well to antibiotic treatment

A

Bacterial Conjunctivitis

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21
Q

What are the similar symptoms both viral and bacterial conjunctivitis share?

A

Burning, Itching, Redness, Watering of the eyes

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22
Q

What three forms of bacterial conjunctivitis are most concerning?

What is unique about one of them regarding treatment?

A

Neonatal
Gonorrhea
Chlamydia - ABx resistent

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23
Q

This form of conjunctivitis occurs more acutely/suddenly, presents with marked conjunctival/lid swelling and white non-purulent drainage, and also does not respond to ABx

A

Allergic conjunctivitis

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24
Q

How do you treat allergic conjunctivitis?

A

Cool Compresses
Topical Antihistamine
Allergy Reducing drops

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25
Q

How do you treat bacterial conjunctivitis?

A

Abx

Sulfacetamide
Ofloxacin
Ciprofloxacin
Trimethaprim/Polymysin
Tobramycin
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26
Q

Are Bacterial, Viral, and allergic conjunctivitis contagious?

A

Bacterial and Viral - YES

Allergic - No

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27
Q

This form of conjunctivitis with primary HSV in child hood and recurrent in adulthood and is associated with stomatitis and fever blisters.

A

Herpetic Conjunctivits

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28
Q

This form of conjunctivitis occurs following a chemical injury to the eye causing epithelial and limbal damage/tissue loss?

A

Chemical/Toxic Keratoconjunctivitis

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29
Q

Would a chemical injury from an acid or a alkali be more concerning?

A

Alkali - because it can lead to blinding

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30
Q

How do you treat Chemical/Toxic Keratoconjunctivitis?

A

Irrigation to normalize the pH of the eye

It should be neutral between 6.5-7.5

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31
Q

This is a very common benign growth that causes the eye to get red and irritated.

A

Pingueculum

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32
Q

This is a common slow benign fibrovascular tissue growth from the conjunctiva to the cornea which may start to obscure vision.

A

Pterygium

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33
Q

This disease causes dry eyes and excess tearing.

A

Keratoconjunctivitis Sicca

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34
Q

This disease involves inflammation of the sclera in the eye and is frequently associated with systemic inflammatory diseases such as RA, Lupus, or sarcoidosis

A

Scleritis

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35
Q

What symptoms would a patient experience if they had scleritis?

What symptoms would you not see?

A

Redness
Tenderness to palpation
Blurry Vision

NO Discharge/Itching

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36
Q

What is the most concerning complication of scleritis?

A

Necrotizing scleritis (Loss of the eye)

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37
Q

This disease is a SEVERE internal eye infection in which the anterior chamber and/or vitreous fluid becomes filled with purulence typically following a puncture wound or surgery

A

Endophthalmitis

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38
Q

What is a Hypopyon? (Typically found in someone with Endophthalmitis)

A

A layer of WBCs or purulence in the anterior chamber

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39
Q

Endophthalmitis can be caused by an extension of a ______ ______ or endogenously by a _____ _____.

A

Corneal infection

Septic emboli

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40
Q

What is the most concerning complication of Endophthalmitis?

A

Loss of vision

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41
Q

This is typically caused by BLUNT trauma which results in blood filling the anterior chamber of the eye causing mild pain and blurry vision.

A

Hyphema

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42
Q

What is the most concerning complication of a hyphema?

What is the mechanism of this?

A

Vision Loss

Blood filled the anterior chamber blocking the mechanisms that typically drain aqueous humor, which causes a rise in IOPs. This rise in pressures can in turn cut off blood supply to the eye

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43
Q

This type of hyphema occurs when blood completely fills the anterior chamber giving it an almost black appearance.

A

8-Ball hyphema

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44
Q

A __________ laceration only involves the superficial layers of the eye.

A

Conjunctival

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45
Q

T/F: A patient with a conjunctival laceration will have normal vision?

A

True

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46
Q

This typically results from grinding, drilling, and cutting metals and is painful.

A

Corneal foreign body

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47
Q

How do you test for a corneal foreign body?

A

Slit Lamp

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48
Q

How do you treat a corneal foreign body?

A

Irrigate or swab foreign body
Removed with slit lamp and a needle

Topical ABx +/- NSAIDs

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49
Q

What precautions should be taken to prevent corneal foreign bodies?

A

Wear safety glasses

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50
Q

A _______ abrasion is typically very pain painful, is traumatic (ie: finger to the eye), and involves a loss in the epithelial layer

A

Corneal

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51
Q

What are the symptoms of a corneal abrasion?

A

Blurry Vision
Foreign Body Sensation
Photophobia
Can’t Open the Eye

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52
Q

How do you diagnose a corneal abrasion?

A

Wood’s Lamp (Flourescein Uptake)

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53
Q

T/F: A patient with a corneal abrasion will typically feel immediate relief with anesthetic drops?

A

True

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54
Q

How do you treat a corneal abrasion?

A 
Topical ABx (Erthyomicin/Tobramycin) 
Pain Management
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55
Q

A _______ or _______ laceration results in aqueous humor, iris, retinal, or vitreous contents leaking out of the eye.

A

Corneal/Scleral

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56
Q

A corneal/scleral laceration occurs from ______ trauma to the eye.

A

Sharp (Knife, Fish Hook)

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57
Q

What Sx might a person with a scleral/corneal laceration experience?

A

PAIN
Photosensitivity
Blurry Vision
Watery eyes

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58
Q

If seen in an emergency/urgent care/primary care setting, how should you treat a corneal/scleral laceration?>

A

Shield and immediate referral

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59
Q

What is the prognosis of a corneal/scleral laceration if treated urgently?

A

Good

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60
Q

This is the inflammation of the cornea, typically bacterial, inflammatory, or viral, and presents uniquely with translucent or opaque lesions on the cornea

A

Keratitis

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61
Q

T/F: Keratitis is frequently associated with systemic inflammatory disease

A

True

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62
Q

What is the most prominent Sx in Keratitis?

What additional symptoms might you see?

A

PHOTOSENSITIVITY

Pain
Redness
Blurry Vision
Mucus Discharge

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63
Q

What is the most concerning complication in a patient with keratitis?

A

Developing necrotizing scleritis

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64
Q

_______ keratitis is a milder form and has an accumulation of WBCs in the cornea

A

Marginal

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65
Q

T/F: Marginal keratitis does not leave the epithelium intact so it would stain with flourescein

A

False: Marginal Keratitis leaves the epithelium INTACT, so it WOULD NOT stain with flourescein

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66
Q

How do you treat marginal keratitis?

A

ABx
NSAIDs
Lid Scrubs

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67
Q

Keratitis can often developed from wear what too long?

A

Contact lens

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68
Q

________ keartitis often results from pseudomonas or Amoebas caught while swimming in a lake

A

Bacterial

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69
Q

What will bacterial conjunctivitis progress to if not treated aggressively?

A

Corneal Ulcer

70
Q

What test should you preform is you are concerned for bacterial keratitis?

71
Q

How do you treat bacterial keratitis?

A
  1. AGGRESIVE and FREQUENT Abx as they do not respond to typical ABx concentrations (MAY NEED PHARMACISTS HELP)
  2. Daily follow up
72
Q

T/F: Bacterial Keratitis from Amoebas will respond to steroids?

A

False, they WILL NOT respond to steroids

73
Q

This is caused by inflammation in the anterior segment, Iris, and ciliary body, has WBCs floating in the aqueous humor, and is often associated with systemic inflammatory conditions.

A

Iritis/Uveitis

74
Q

What are the FOUR common causes of Iritis/Uveitis?

A
  1. Idiopathic (>50%)
  2. Traumatic
  3. Infectious
  4. HLA-B27 Associated
75
Q

What are the symptoms of iritis/uvetitis?

A 
Pain
Redness
Tearing
Photophobia
Soreness
76
Q

T/F: A patient with iritis/uveititis will get relief from topical anesthetics?

77
Q

On physical examination, what do you do you expect to find when examining the patient’s pupils with iritis/uveitis?

A

Poor reactivity

78
Q

How is iritis/uvetitis treated?

A

topical steroids

cycloplegic (dilation)

79
Q

_______ iritis is typically associated with blunt trauma but does not cause a hyphema.

80
Q

What would you expect to see in floating in the aqueous humor in a patient with traumatic iritis?

81
Q

Symptoms (pain, redness, photophobia, etc…) of traumatic iritis typically onset how many days after the trauma?

82
Q

In a patient with an orbital blow out fracture, what are you most concerned with?

A

Extraocular muscle entrapment
Unresolved diplopia
Large fracture
Globe displacement

These would typically be surgically repaired

83
Q

This RARE disorder occurs when the natural lens it not where it should be

A

Ectopia Lens

84
Q

Ectopia lens is typically seen in patients with ______ syndrome

85
Q

How is ectopia lens treated?

A

Surgically

86
Q

This is the most common cause of vision lose and is often related to aging.

87
Q

What additional risk factors (other than age) are associated with cataracts?

A
  1. DM
  2. Steroids
  3. Smoking
  4. UV light
  5. Trauma
88
Q

T/F: Cataracts is fully reversible with surgery

89
Q

This disease is chronic and slow progressing, typically involves gradual peripheral vision lose, and is typically asymptomatic at first

A

Chronic open-angle glaucoma

90
Q

In a patient with chronic open-angle glaucoma, what would you be monitoring to ensure minimal optic nerve damage?

91
Q

This form of glaucoma occurs acutely and IOPs are typically 60-80 mm Hg, and is associated with headaches, nausea, and emesis

A

Angle closure glaucoma

92
Q

How do you work up a patient for angle closure glaucoma once you have confirmed elevated IOPs?

A

Gonioscopy
OCT of the nerve fiber layer

Tx: Laser iridotomy

93
Q

What is the most concerning complication of angle-closure glaucoma if not treat emergently?

A

Blindness (optic nerve damage)

94
Q

This very common disease is an inflammation of the eyelids caused by a plugging of the meibomian (oil) glands

A

Blepharitis

95
Q

What bacteria is typically associated with blepharitis?

96
Q

What symptom is unique to blehparitis?

A

Scalyness of the eyelid

97
Q

How do you treat blepharitis?

98
Q

A ________ is the obstruction of a meibomian gland in the tarsal plate

A _______ is swelling associated with a lash follicle

Both of these are commonly referred to as what?

A

Chalazion

Hordeolum

Stye

99
Q

What symptoms would you expect to see in a patient with a Chalazion/Hordeolum?

A

Tender/Sore “bump” on the eyelid

Burning/Itching

100
Q

How do you treat a Chalazion/Hordeolum?

A

Abx

Hot Compresses

101
Q

This is the inflammation of the lacrimal gland typically associated with swelling/tenderness/soreness of the upper orbit

A

Dacryoadenitis

102
Q

What two additional symptoms along with the swelling and tenderness of the upper orbit would a patient with dacryoadenitis experience?

A

Fever

Mucopurulent Drainage

103
Q

This disease occurs due to immune complexes of thyroid disease

A

Thyroid Eyes Disease (Graves)

104
Q

What unique symptoms would you see in a patient with Graves Disease?

What causes this?

A

Proptosis (A Bulging of the eyes)

This is caused by an increase in the volume of orbital tissue (Muscle/Fats) pushing the globe forward

105
Q

What additional symptoms, other than proptosis, would you see in a patient with Graves Disease?

A

Diplopia
Pain
Dryness

106
Q

What are the two types of occular dysmotility

A

Esotropia - one eye goes in toward the nose

Exotropia - one eye goes outward toward the ear

107
Q

T/F: You should refer any child with strabismus

108
Q

T/F: You should refer any asymptomatic adult with strabismus

109
Q

This occurs when there is an infection of the skin near the eyelids and develops from styes, lacerations, or conjunctivits

A

Pre-septal cellulitis

110
Q

What Sx are you likely to see in a patient with orbital cellulitis?

A

Swelling
Pain
Eyelid closure
Discharge

111
Q

Will a patient with pre-septal cellulitis have normal vision and motility?

A

Most likely

112
Q

This occurs from an infection in the orbital tissues and is typically associated with an abcess in the adjacent sinus

A

Orbital cellulitis

113
Q

What are the primary symptoms in a patient with orbital cellulitis?

A
  1. Eye Bulging
  2. Swelling
  3. Fever
  4. Visual Changes
  5. Pain with EOMs
114
Q

How should you work up a patient with suspected orbital cellulitis?

A

CT/MRI (Emergency)

115
Q

How do you treat orbital cellulitis?

A
  1. Hospitalization for IV Abx and possible I&D
  2. ENT/Oculopplastic surgery
  3. Neurosurgery if extending into brain
116
Q

T/F: Fungal orbital cellulitis has a high mortality rate

117
Q

This disease is the inflammation of the optic nerve which can be papillitis or retrobulbar

A

Optic neuritis

118
Q

What are the four causes of inflammatory optic neuritis?

A

Lyme
Syphilis
Malaria
MS

119
Q

What are the five causes of autoimmune optic neuritis?

A 
Lupus
Polychondiritis
Crohns
UC
Wegners
120
Q

What are the four causes are toxic optic neuritis

A

Methanol
Ethanol
Lead
Chloramphenicol

121
Q

What are three additional causes of optic neuritis that dont fall under inflammatory, autoimmune, or toxic?

A

Ischemic
Neuropathy
GCA

122
Q

What are the three general symptoms of Optic neuritis?

A

Blurry Vision
Vision Loss
Pain with EOM

123
Q

This is the most common cause of demyelinating disease with regards to sudden vision loss and central scotoma

124
Q

This phenomenon occurs when neurological symptoms worsen with heat (ie. hot showers)

A

Uhtoff Phenomenon

125
Q

This sign occurs when a patient feels an electric sensation down the spine with neck bending

A

Lhermitte’s Sign

126
Q

This phenomenon occurs when patients view pendulums as moving in an elliptical manner

A

Pulfrich Phenomenon

127
Q

How do you work up MS/Retrobulbar Optic Neuritis?

A

MRI - multiple episodes of lesions separated by time and space

Dawson’s fingers (periventricular white matter lesions)

128
Q

How do you treat MS/Retrobulbar optic neuritis

A

IV Steroids/Immunmodulatory drugs

129
Q

What additional diseases should be ruled out when testing for MS/Retrobulbar Optic Neuritis

A

Syphilis

GCA

130
Q

This disease is also referred to as temporal arteritis and is an inflammatory condition of the head

A

Giant Cell Arteritis

131
Q

What are unique symptoms of GCA?

A

Unilateral vision loss
Jaw soreness with chewing
Temporal tenderness (ie. with brushing hair)
Headache

132
Q

What age range are most likely to have GCA?

Are men or women more likely to have GCA?

A

> 50 y.o.

Women > Men

133
Q

If GCA is not treated will the patient continue to have unilateral vision loss or will it spread?

A

It will quickly spread to the other eye

134
Q

What two lab values are key to diagnosing GCA?

135
Q

What is the gold standard for GCA diagnosis?

A

Temporal artery biopsy (3-4 mm)

136
Q

How do you treat GCA?

A

1 year of steroids with a VERY GRADUAL taper

137
Q

This disease occurs because of bilateral optic neuritis due to increased intracerebral pressures

A

Papilledema

138
Q

What are the five risk factors/causes of papilledema?

A 
Tumors
Pseudotumors
Lyme Disease
Infection
Malignant HTN
139
Q

What is the primary symptom of papilledema?

A

blurry vision

140
Q

How should you work up papilledema (TWO THINGS)?

A
  1. Imaging to r/o tumor

2. LP to measure CSF pressures

141
Q

Understand hemianopsia and the different forms and visual field losses

A

Work through it

142
Q

What are the two forms of diabetic retinopathy?

A

Non-proliferative

Proliferative

143
Q

What is the primary exam finding in a patient with MILD Non-proliferative diabetic retinopathy?

A

Microaneurysms

NO blot hemorrhages

144
Q

What is the primary exam finding in a patient with MODERATE Non-proliferative diabetic retinopathy?

A

Microaneurysms AND blot hemorrhages

145
Q

What is the primary exam finding in a patient with SEVERE Non-proliferative diabetic retinopathy?

A

4 quadrant with >20 microaneurysms

2 quadrants with venous bleeding

1 quadrant with intraretinal microvascular abnormalities

146
Q

What is the primary exam finding in proliferated diabetic retinopathy?

A

New blood vessel growth

147
Q

What are the FOUR causes of vision lose in a patient with diabetic retinopathy?

Are these painful or painless?

A 
Macular Edema (Painless)
Vitreous Hemorrhage (Painless)
Retinal Detachment (Painless)
Neovascular Glaucoma (Painful)
148
Q

What causes neovascularization?

A

The retina feels like it is “sick” because it is being damage by the excess sugar. Due to this it releases VEG-F which stimulates vessel growth

149
Q

How do you treat non-proliferated diabetic retinopathy?

A

Observation

150
Q

How do you treat macular edema in diabetic retinopathy patients?

A

Laser therapy

Anti-VEG-f injections

151
Q

How do you treat proliferated diabetic neuropathy patients?

A

Panretinal Photocoagulation Laser

152
Q

How do you treat neovascular glaucoma in diabetic retinopathy patients?

A

Anti VEG-f with PRP

Glaucoma Surgery

153
Q

This is acute onset of decrease vision or blind spots commonly do to arterioclerotic changes in the vessels?

A

Branch Retinal Vein Occlusion

154
Q

These arteriosclerotic changes that cause arteries to “cross over and occlude” veins is also referred to as what?

A

AV nicking

155
Q

What are THREE risk factors for BRVO?

What is NOT a risk factor?

A
  1. HTN
  2. Cardiovascular disease
  3. Glaucoma

DM is NOT a risk factor

156
Q

This is the acute onset of vision loss usually associated with a thrombosis at the CRV.

A

Central Retinal Vein Occlusion

157
Q

Is DM a risk factor for BRVO or CRVO or Both?

158
Q

This occurs when there is sudden painless vision loss and has a very poor prognosis

A

Central Retinal Artery Occlusion

159
Q

Irreversible damage can occur in only __ minutes in a patient with a CRAO.

Is there an effective treatment?

160
Q

What do you need to work up in a patient with CRAO? Why?

A

You need to look for the source of the embolus because if you can throw a clot to your retinal artery it is likely you are at risk for clotting in other places

EX: Labs, Carotid Dopplers, Etc…

161
Q

This occurs from age-related “wear and tear” to the retina and outer retina

A

Age-related macular degeneration

162
Q

What are the two types of age-related macular degeneration?

Which typically comes first?

A

Dry (FIRST)

Wet

163
Q

What physical examination finding would be consistent with age-related macular degeneration?

164
Q

What occurs uniquely with WET age-related macular degeneration?

A

Neovascularization which increases fluid and swelling

165
Q

What are the FOUR risk factors for age-related macular degeneration?

A

> 50 y.o
Smoking
Caucasian
FHx

166
Q

How is dry age-related macular degeneration treated?

How is wet age-related macular degeneration treated?

A

DRY:

  1. Amsler
  2. AREDS vitamins
  3. Routine Examination

WET:

  1. Anti-VEG-f
  2. Cold Laser therapy
167
Q

What are the three types of retinal detachment?

A
  1. Rhegmatogenous (Most Common)
  2. Serous (Inflammation)
  3. Traction (DM)
168
Q

Understand how a retinal detachment occurs

A

A tear develops in the retina and then vitreous fluid leaks out underneath and gets behind the retina, lifting/detaching it

169
Q

What Sx might you expect a patient with a retinal detachment to be experiencing.

A

They may be seeing “floaters”, “flashers”, or “curtains”

THINK: “someone threw pepper in there visual fields”

170
Q

How is a retinal detachment treated? What types?

A

Surgically

Laser Retinopexy
Pneumatic Retinopexy
Scleral Buckle
Vitrectomy

Clinical Medicine 1 (6 decks)

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