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PBR: Ophthalmology and ENT > Eye Disorders > Flashcards

Eye Disorders Flashcards

1
Q

What are some (5) abnormalities that can cause an abnormal red reflex?

A

Strabismus, cataracts, glaucoma, retinoblastoma, and high refractory error.

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2
Q

What are the (3) leading causes of blindness in children in the U.S.?

A

Cortical visual impairment, retinopathy of prematurity, and optic nerve hypoplasia.

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3
Q

What is the leading cause of acquired blindness in children in the U.S.?

A

Ocular trauma, most often following a sports-related injury or an accidental or intentional injury by another child.

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4
Q

What is strabismus?

A

Strabismus is the continuous or intermittent malalignment of one or both eyes, in which one or both eyes are turned in (esotropia), out (exotropia), up (hypertropia), or down (hypotropia).

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5
Q

Define esotropia.

A

A condition in which one or both eyes are abnormally turned in.

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6
Q

Define exotropia.

A

A condition in which one or both eyes are abnormally turned out.

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7
Q

Define hypertropia.

A

A condition in which one or both eyes are abnormally turned up.

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8
Q

Define hypotropia.

A

A condition in which one or both eyes are abnormally turned down.

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9
Q

Describe the cover/uncover test and what it is used to diagnose.

A

An abnormal cover/uncover test shows movement of the uncovered eye that is fixated on a target when the other eye is covered. It is concerning for strabismus.

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10
Q

At what age should a child be referred for further evaluation if strabismus is elicited on exam?

A

Strabismus can be normal in early infancy, but if it persists past 4 months of age then the child should be referred to ophthalmology.

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11
Q

What examination findings would differentiate pseudoesotropia from true strabismus?

A

On formal testing, a symmetric light reflex and a normal cover/uncover test would rule out true strabismus and confirm the diagnosis of pseudoesotropia.

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12
Q

Define amblyopia.

A

Amblyopia is a functional reduction in visual acuity caused by disuse or misuse of visual pathways. It also affects depth perception and binocularity.

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13
Q

What are the causes of amblyopia?

A

It can result from early childhood refractive disorders, strabismus, cataracts, corneal opacities, or anisometropia (an unequal refractive error between the eyes).

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14
Q

What is the most common cause of visual loss in individuals <45 years of age?

A

Amblyopia

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15
Q

How is amblyopia treated?

A

Have the child use the amblyopic eye by patching the better-seeing eye with either a patch or cycloplegic eye drops.

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16
Q

What is the incidence of color vision abnormalities in boys compared to girls?

A

Abnormal color vision occurs in 8-10% of males and <0.5% of females. It exhibits X-linked inheritance.

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17
Q

What causes cortical visual impairment?

A

Damage to the geniculostriate pathway (visual cortex and optical radiations) results in cortical visual impairment. Hypoxia is the most common cause, but it can also occur due to meningitis, encephalitis, metabolic disease, head trauma, and hydrocephalus.

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18
Q

How does cortical visual impairment present clinically?

A

There is reduced vision and absence of optokinetic nystagmus but the pupillary light reflexes are intact. Many affected children have other abnormalities as well, such as cerebral palsy, seizures, or paralysis.

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19
Q

Define nystagmus.

A

Nystagmus is an involuntary oscillation of the eyes. Movements can be either pendular (smooth like a pendulum) or jerky.

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20
Q

Which brain lesion is suggested by an upbeating jerk nystagmus?

A

Upbeating jerk nystagmus usually indicates a lesion in the pons but can be seen in lesions of the medulla or cerebellum (i.e. infratentorial).

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21
Q

Which brain lesion is suggested by an downbeating jerk nystagmus?

A

Downbeating jerk nystagmus indicates a lesion at the cervicomedullary junction.

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22
Q

What conditions should be on the differential for patients who present with painful red eyes?

A

Conjunctivitis, corneal abrasion, foreign body, subconjunctival hemorrhage, glaucoma, iritis, keratitis, and scleritis.

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23
Q

Which patients who present with painful red eyes require urgent ophthalmology referral?

A

If patients have moderate-to-severe pain with associated vision abnormalities, they should be referred to ophthalmology, as there is likely to be a serious underlying cause.

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24
Q

Define conjunctivitis.

A

Conjunctivitis is an inflammation of the conjunctiva that can be either infectious (viral vs bacterial) or noninfectious (typically allergic).

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25
Q

What is the most common infectious etiology for conjunctivitis?

A

Adenovirus

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26
Q

What are some (3) common bacterial etiologies for conjunctivitis?

A

Strep pneumoniae, Haemophilus influenzae, and moraxella catarrhalis.

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27
Q

What is the typical treatment for patients with viral conjunctivitis?

A

There is no specific treatment, but lubricant drops may be used for symptomatic relief.

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28
Q

What is the typical treatment for patients with bacterial conjunctivitis?

A

Erythromycin ophthalmic ointment or trimethoprim-polymyxin drops 4x/day for 5-7 days.

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29
Q

What alternative antibiotic treatment regimen should be used for treatment of bacterial conjunctivitis in contact lens wearers?

A

Use fluoroquinolone drops in these patients due to the increased risk of Pseudomonal conjunctivitis.

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30
Q

What are the symptoms of a corneal abrasion?

A

Pain, tearing, photophobia, and blurry vision. Infants can present with inconsolable crying.

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31
Q

Which patients are at higher risk for development of corneal ulcers?

A

Contact lens wearers.

32
Q

How do you diagnose a corneal abrasion?

A

Diagnosis is best made with fluorescein dye and either a Wood’s lamp or the blue light of a slit lamp.

33
Q

What is the recommended treatment for corneal abrasions?

A

Topical antibiotic ointment and oral analgesia. Topical anesthetics may be used in the ED or office to provide temporary relief during examination but should not be prescribed for home use as they can be toxic to the cornea with repeated use.

34
Q

What should you worry about if a patient is found to have multiple verticle abrasions with fluorescein staining of the cornea?

A

Multiple vertical abrasions suggest a foreign body retained in the upper eyelid.

35
Q

How does one differentiate between preseptal and orbital cellulitis?

A

Both present with eye pain and a red, swollen eyelid. Only orbital cellulitis causes pain with eye movement, ophthalmoplegia, chemosis, and/or proptosis.

36
Q

Define preseptal cellulitis.

A

Preseptal cellulitis is an infection of the eye involving tissues anterior to the orbital septum.

37
Q

Define orbital cellulitis.

A

Orbital cellulitis is an infection involving structures behind the orbital septum.

38
Q

What imaging study is required for diagnosis of orbital cellulitis?

A

CT scan of the orbit(s).

39
Q

Which pathogens are typically responsible for the development of preseptal cellulitis?

A

Staph aureus and strep pyogenes when the infection originates from local trauma, and S. pneumoniae when it originates from sinusitis.

40
Q

What is the typical treatment for preseptal cellulitis?

A

Treatment is usually outpatient and consists of 7-10 days of clindamycin OR combination therapy with trimethoprim/sulfamethoxazole + one of the following: amoxicillin, amoxicillin/clavulanic acid, cefpodoxime, or cefdinir.

41
Q

Which patients diagnosed with preseptal cellulitis should be admitted to the hospital for treatment?

A

Patients < 1 year of age should be hospitalized.

42
Q

Which pathogens are typically responsible for the development of orbital cellulitis?

A

It typically originates from sinusitis and is caused by multiple organisms. The most commonly identified pathogens are S. aureus and streptococci.

43
Q

What is the recommended treatment for orbital cellulitis?

A

Patients should be admitted for parenteral antibiotic therapy with either vancomycin + ampicillin/sulbactam or monotherapy with ceftriaxone. Once the patient exhibits clinical improvement, they may be transitioned to the same oral antibiotic regimen used for preseptal cellulitis. Patients should receive a total antibiotic course of 2-3 weeks duration.

44
Q

Name three possible complications of orbital cellulitis.

A

Orbital abscess, subperiosteal abscess, and intracranial extension.

45
Q

What is a chalazion?

A

A localized bump at the edge of the eyelid caused by a blockage of the meibomian glands, which produce oil.

46
Q

What is a stye/hordeolum?

A

A stye/hordeolum is an infected chalazion.

47
Q

What is the typical course of a chalazion?

A

Chalazions typically resolve without treatment within a few months. If persistent after that time, referral can be made to ophthalmology for incision and curettage.

48
Q

What is the recommended treatment for a stye/hordeolum?

A

Styes are usually red and painful for ~3-5 days before they rupture, and then they heal in about a week. Warm compresses may be used to hasten rupture.

49
Q

Describe the typical presentation of a dacryostenosis (nasolacrimal duct obstruction).

A

It is very common in newborns and typically presents as persistent tearing in the affected eye.

50
Q

What is the recommended treatment for dacryostenosis (nasolacrimal duct obstruction)?

A

Treatment consists of lacrimal sac massage, and 90% of cases resolve by 6 months of age.

51
Q

What is a cataract?

A

A cataract is an opacification of the lens.

52
Q

What is the significance of a unilateral cataract in an infant?

A

Unilateral congenital cataracts are usually sporadic and not associated with systemic disease.

53
Q

What are some diseases which may present with bilateral congenital cataracts?

A

AD congenital cataracts, Trisomy syndromes (13, 18, and 21), metabolic disorders (e.g. galactosemia), and intrauterine infections (i.e. TORCH).

54
Q

What are some factors which can lead to the development of cataracts in older children?

A

Ocular trauma, glucocorticoid treatment, and ionizing radiation.

55
Q

What is the most useful physical exam test to detect lens opacity?

A

The simultaneous red reflex test is the most useful assessment to detect lens opacity.

56
Q

Which characteristics of a cataract would require procedural removal?

A

Cataracts which are centrally located and >3mm require immediate removal to prevent vision loss. Smaller cataracts may be observed if asymptomatic but must also be removed at the first sign of visual interference.

57
Q

Define papilledema.

A

Papilledema refers to optic nerve swelling due to increased intracranial pressure.

58
Q

Name four possible causes of papilledema.

A

Mass lesion, cerebral edema, obstructive hydrocephalus, and pseudotumor cerebri.

59
Q

What imaging study should be performed if papilledema is identified on physical exam?

A

MRI brain

60
Q

What is the next step in diagnosis if a patient with papilledema is found to have a normal MRI brain?

A

Lumbar puncture should be performed with opening pressure to evaluate for possible pseudotumor cerebri.

61
Q

Define retinopathy of prematurity.

A

A developmental proliferative vascular disorder that occurs in the retina of preterm infants with incomplete retinal vascularization.

62
Q

What are the most common risk factors for ROP?

A

Prematurity is the most important risk factor, followed by low birth weight. Other risk factors include elevated arterial oxygen tension, assisted ventilation for >7 days, surfactant therapy, hyperglycemia, insulin therapy, and cumulative illness severity.

63
Q

Define optic nerve hypoplasia and list typical physical exam findings.

A

Optic nerve hypoplasia is a nonspecific finding due to damage of the visual system prior to full development. It is characterized by pallor of the disc, loss of substance of the nerve head, and enlargement of the disc cup.

64
Q

What are the most common causes of optic atrophy in children?

A

Intracranial tumors and hydrocephalus.

65
Q

Name three examples of midline facial defects.

A

Optic nerve hypoplasia, single central incisor, and cleft lip/palate.

66
Q

What is the most prevalent malignant ocular tumor in childhood?

A

Retinoblastoma

67
Q

How does retinoblastoma usually present?

A

Retinoblastoma typically presents with a white pupillary reflex (leukocoria). However, strabismus may also be the initial presenting complaint.

68
Q

Which malignancies are more common in patients diagnosed with heritable retinoblastoma?

A

Osteosarcoma, soft tissue sarcomas, and malignant melanoma.

69
Q

What is hyphema?

A

Hyphema is the presence of blood in the anterior chamber of the eye.

70
Q

What physical exam findings would be concerning for orbital globe rupture?

A

Teardrop-shaped or eccentric pupil.

71
Q

What is the typical treatment for patients diagnosed with hyphema?

A

Eye should be protected from further trauma with a rigid eye shield and ophthalmology should be consulted. Hyphema is then treated with topical steroid and cycloplegic drops, with analgesics and ondansetron used symptomatically to decrease intraocular pressure.

72
Q

What is the typical outcome for children diagnosed with hyphema?

A

Most children with minor hyphema do well, but they are at risk for rebleeding (usually within 1 week of initial injury). Rebleeding increases the risk for long term complications such as glaucoma.

73
Q

What symptoms would you expect in a patient diagnosed with an orbital floor fracture?

A

Vertical diplopia, cheek numbness, limited upward gaze, circumferential ecchymosis, subconjunctival hemorrhage, hyphema, and enophthalmos (sunken eye) can all be seen in this type of injury.

74
Q

What imaging study should be performed if orbital floor fracture is suspected?

A

CT scan of the orbit(s).

75
Q

What is the recommended treatment for orbital floor fractures?

A

Advise patients to avoid blowing their nose and prescribe antibiotics to prevent infection. Refer to a maxillofacial surgeon, as operative treatment will likely be needed.

PBR: Ophthalmology and ENT (9 decks)

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