Eye (Mehrhoff) Flashcards
Hordeolum
an acute purulent soft mass in the periorbital region; if does heal properly can become a chalazion
If a hordeolum doesn’t heal properly, what can it turn into?
chalazion
Chalazion
chronic lipogranuloma from an obstructed meibomiam gland; roundish, firm lesion painLESS lesion within the tarsal plate.
Sebaceous Adenocarcinoma of the eyelid
small, rubbery/firm nodule on upper eyelid (can mimic chalazion); slow-growing tumor with atypical epithelial cells; tends to metastasize; elderly and female predominate; yellowish appearance is a suspicious sign
What is a sign that can help you distinguish a Sebaceous Adenocarcinoma of the eyelid from a Chalazion?
yellowish appearance - more towards Sebaceous Adenocarcinoma of the eyelid (also look for macaronis - loss of eyelashes)
Basal cell carcinoma
most common malignant lesion of the eyelid (90%); flesh-colored to pearly raised nodule with “rolled edges”; rarely metastases; peak age of 70 yrs
What is the most common malignant lesion of the eyelid?
Basal cell carcinoma
A description of a flesh-colored to pearly raised nodule with “rolled edges”on the eyelid should make you suspect what?
Basal cell carcinoma
Squamous cell carcinoma
most common skin cancer; predominately amongst dark-skinned individuals; erythematous pink nodules with overlying scale or crust; may find “horn pearls”
What is the most common skin cancer?
Squamous cell carcinoma
A description of erythematous pink nodules with overlying scale or crust and some “horn pearls” around the eyelid should make you suspect what?
Squamous cell carcinoma
Melanoma of the eyelids
ABCDE’s of melanoma (asymmetry, border irregularities, color with black and blue hues, diameter >6mm and change in the lesion over time); looks for loss of eyelashes; associated with high mortality
When light passes through the cornea and the lens, what is the orientation of the image?
Inverted and reversed (refracted)
Hyperopia
farsightedness; corrected with convex lens
Myopia
nearsightedness; corrected with concave lens
Astigmatism
abnormal curvature of cornea; corrected with cylindrical lens
Cataracts
painless opacification of the lens; nuclear is most common type - nuclear sclerosis increases the lens refraction and leads to increased myopia and decreased hyperopia
What is the most common type of cataracts?
nuclear cataracts
Explain the flow aqueous humor?
posterior chamber to pupil and then can go down one of two routes:
1. trabecular route - trabecular meshwork at angle of anterior chamber to scheme’s canal
2. uveoscleral route - uveal meshwork at ciliary muscles to the suprachoroidal space
both routes lead to the episcleral veins
What are two structures that are compressed due to increased intraocular pressure (IOP) seen in glaucoma?
- optic nerve - leads to cupping
- vessels - ischemia of the optic nerve
Glaucoma
group of optic neuropathies with cupping that lead to visual field defects due to obstruction of aqueous humor drainage; most cases lead to increased intraocular pressure (IOP)
Open-angle glaucoma
“silent thief of sight” - no pain unless IOP is very high; resistance of AH flow in the trabecular meshwork (obstruction)
What is a major risk factor to neovascular glaucoma?
type II diabetes with proliferative stage of diabetic retinopathy
Retinal detachment
separation of the neurosensory retina from the RPE; check for “floaters and flashes” in the patient history; can be a description of “curtain drawn down”; there is no pain and fundoscopy can show crinkling of retina; is a surgical emergency
“curtain drawn down” visual description should make you suspect which pathology?
Retinal detachment
What are some irreversible markers of hypertension in the eye?
narrow arterioles, arteriovenous nicking and arteriolar thickening (silver wiring)
Central retinal vein occlusion
dilation and retinal hemorrhages described as “blood and thunder” veins; patient can present with painless vision loss or blurry vision
A description of blood and thunder” veins in the eye, should make you suspect what?
Central retinal vein occlusion
Central retinal artery occlusion
will see a cherry-red center of the macula; boards will typically say patient had sudden and painless vision loss (greater degree compared to the central retinal vein occlusion)
If you suspect diabetic retinopathy in a patient, what is something you should check/monitor?
intraocular pressure (IOP)
Retrobulbar neuritis
inflammation of the posterior part of the optic nerve due to demyelination; typically monocular presents with subacute vision loss, color blindness** and moderate eye pain; attacks resolves spontaneously; associated with MS (get MRI)
Retrobulbar neuritis is associated with what neurological disorder?
Multiple sclerosis (MS); get a MRI of brain and cervical and thoracic spine
Retinopathy of Prematurity (ROP)
immature retinal tissue that leads to tractional retinal detachment causing vision loss or blindness in an infant
Risk factors for retinopathy of prematurity?
extremely low birth weight infants
prematurity (<32 weeks)
respiratory distress infants
exposure to hyperoxia
How does exposure to hyperemia contribute to retinopathy of prematurity in infants?
premature infants are given supplemental oxygen and exposed to hyperemia and this tells the eye we are oxygen sufficient and stops peripheral retinal vessel growth, leads to retinal hypoxia and neovascularization of incompetent vessels that leak and cause elevation and detachment of the retina
Retinoblastoma (RB)
most common intraocular tumor in children (under 5 yrs); germinal mut on chromosome 13q14; patient presents with leukocoria and strabismus
If you suspect that a patient has conjunctival melanoma, why shouldn’t you get a biopsy?
it may shed malignant cells; refer to a specialist
Uveal melanoma commonly spreads to which organ?
liver
Uveal melanoma
malignancy of the uveal; asymptomatic; can see a gray-brown lesion of the choroid with irregular fuzzy margins “classic mushroom-shape”; common hematogenous metastases to the liver
A “classic mushroom-shape” on the eye, should make you suspect which malignancy?
Uveal (choroidal) melanoma
D is the correct answer
MS is a disease characterized by demyelination of CNS nerves; cranial nerves I and II are the only cranial nerves that are direct extensions of the brain (CNS with oligodendrocytes all other transition to schwann cells)
D is the correct answer
