Eye Exam

Question 0

Unilateral vision loss (non-painful): ddx?

Unilateral vision loss (painful): ddx?

Answer 0

Non-painful: vitreous humor hemorrhage, macular degeneration, retinal detachment, retinal vein occlusion, central retinal artery occlusion

Painful: (cornea or anterior chamber involvement)ulcer, uvetitis, traumatic hyphema, acute glaucoma

Question 1

Define: presbyopia, hyperopia, and myopia

Answer 1

Presbyopia: aging vision, farsightedness
Hyperopia: farsightedness
Myopia: nearsightedness

Question 2

Causes of diplopia (bilateral vs. unilateral)

Answer 2

Bilateral: brainstem or cerebellum lesion, weakness/paralysis of extraocular muscles

Unilateral: cornea or lens

Question 3

Definition of “legally blind”

Answer 3

20/200

Question 4

Causes of visual field defects

Answer 4

Anterior pathway (before optic chiasm): glaucoma, optic neuropathy, optic neuritis, glioma

Posterior pathway: stroke, chiasmal tumors

Question 5

What can cause an enlarged blindspot?

Answer 5

glaucoma, optic neuritis, papilledema

Question 6

What can cause Inward or outward deviation of the eyes?

Answer 6

Graves’ disease, ocular tumors

Question 7

What can lateral sparseness in eyebrows mean? (ddx)

Answer 7

hypothyroidism

Question 8

What can cause increased or decreased tearing?

Answer 8

Increased: (increased production)conjunctival inflammation, corneal irritation. (impaired drainage) ectropion-turning out of eyelid, nasal lacrimal duct obstrucion

Decreased:

Question 9

Miosis vs. Myadriasis

Answer 9

Miosis: constriction of the pupils
Myadriasis: dilation

Question 10

What can cause lid lag?

Answer 10

hyperthyroidism

Question 11

What can cause poor convergence?

Answer 11

hyperthyroidism

Question 12

What is the difference between an Afferent Pathway defect (CNII) vs. an Efferent Pathway (CNIII)?

Answer 12

CNII–> loss of direct pupillary reflex, with preservation of indirect pupillary reflex
CNIII–> complete paralysis of ipsilateral pupil

Question 13

What is an Argyll Robertson pupil? Causes?

Answer 13

Lack of pupillary constriction with preservation of pupillary near accommodation

Causes: syphilis, diabetes, and lupus

Question 14

What is Adie Tonic Pupil? Cause?

Answer 14

large pupil caused by damage to parasympathetic ciliary ganglion

Question 15

Facial Motor lesions (UMN vs. LMN)

Answer 15

UMN: Contralateral paralysis of lower face, with forehead sparing
LMN: Ipsilateral paralysis of BOTH lower and upper face

Question 16

Uveitis

Answer 16

inflammation of the iris, ciliary body, and choroids
can be caused by auto-inflammatory disease or infection
blurry vision

Question 17

How is Internuclear Ophthalmoplegia distinguished from CN III palsy?

Answer 17

INO: preserves convergence. Most common in Multiple Sclerosis
CNIII: “Down and out”

Question 18

Marcus Gunn pupil

Answer 18

deficit in afferent light reflex (CN II, retinal detachment)–> affected pupil appears to dilate with light when switched from unaffected eye (but actually returning to baseline from constricted state)

Question 19

Xerophthalmia

Answer 19

Dry eyes

can be caused by Vit. A deficiency or Sjogren Syndrome

Question 20

Macular Degeneration

Answer 20

secondary to disruption of retina–> slow-onset of CENTRAL vision loss, w/ preservation of peripheral vision

Question 21

Amaurosis Fugax (sudden unilateral vision loss) (assoc. with what?)

Answer 21

embolization of ophthalmic artery

Assoc. with carotid bruit and atheroscleosis

Question 22

Glaucoma

Answer 22

due to increased ICP–> optic nerve atrophy

caused by decreased flow of aqueous humor through canal of Schlemm w/ or w/o narrowing of anterior chamber angle