Eyes

Question 1

Optic Neuritis
-Symptoms
-Etiologies
-Testing
-Treatment

Answer 1

-Sudden painful loss of vision, central scotoma
-Marcus-Gunn Pupil (dilates with light)
-MS, Ethambutol, Syphilis
-Young Females
-Optic disc swelling on fundus exam
-MRI confirms
-Treat with IV Methylprednisone then oral corticosteroids

Question 2

Orbital Cellulitis
-Who is it MC in
-Causes
-Symptoms
-Testing
-Treatment

Answer 2

-MC in children
-Polymicrobial: Staph, Strep, H. Flu
-Secondary to sinus infection (ethmoid)
-EOM pain and weakness, eyelid edema, proptosis
-High resolution CT scan of orbits
-Admit + IV ABX (Vanco + Ceftriaxone)

Question 3

Preseptal Cellulitis
-Symptoms
-Treatment

Answer 3

-Unilateral pain, eyelid edema
-No proptosis, EOM pain or weakness
-Outpatient: Oral Clinda or Amox + Bactrim

Question 4

Retinal Detachment
-Unique exam finding on fundus exam
-Treatment

Answer 4

-Schafer Sign: tissue flap like tobacco dust
-Supine with head turned to affected side

Question 5

Hyphema
-What is it?
-What is one condition that is associated?
-Treatment

Answer 5

-Blood in AC
-Sickle cell with trauma
-Bed rest at 45’ elevation, analgesics, eye shield

Question 6

Orbital Floor Fracture
-Symptoms
-Testing
-Treatment

Answer 6

-Diplopia with upward gaze (inferior rectus entrapment)
-Orbital emphysema, anesthesia to cheek (infraorbital nerve stretching)
-CT
-Ampicillin-Sulbactam, Decongestants, avoid blowing nose

Question 7

CRAO
-Symptoms
-Prognosis?
-Fundus Exam Findings

Answer 7

-Painless monocular vision loss, carotid bruit on same side
-Poor Prognosis
-Pale retina, cherry red macula, boxcar vessels

Question 8

CRVO
-Symptoms
-Prognosis

Answer 8

-Sudden painless vision loss
-Extensive retinal hemorrhages, blood and thunder appearance
-Marcus-Gunn Pupil
-Good prognosis

Question 9

Acute Angle Closure Glaucoma
-Risk Factors
-Symptoms
-Treatment
-Definitive Tx:

Answer 9

-RF: Hyperopia, Females, > 60, Dilation
-Halos, mid-dilated fixed pupil
-Eye hard on palpation
-Topical and Systemic (Acetazolamide or IV Mannitol)
-Iridotomy

Question 10

Ocular Chemical Burns
-Treatment

Answer 10

-Irrigate with LR or NS for 30 minutes or 2 L of fluid. pH goal of 7.0-7.4
-Then give Moxifloxacin, Trim-Poly, or E-mycin ointment

Question 11

Scleritis
-Associated conditions
-Symptoms
-Treatment

Answer 11

-RA, SLE
-Deep boring eye pain, pain with EOM
-Violaceous patches beneath bulbar conjunctiva
-Topical corticosteroids after ophthalmologist referral

Question 12

Uveitis
-Associations/RF
-What is seen on fundus exam
-Treatment for both types

Answer 12

-HLA-B27, Sarcoidosis, IBD, CMV, Syphilis
-Inflammatory cell and flare
-Anterior: Topical glucocorticoids
-Posterior: Systemic glucocorticoids

Question 13

Retinoblastoma
-Mutation
-MC…
-Symptoms
-Testing
-Treatment

Answer 13

-Mutation of RB1 gene on chromosome 13
-MC ocular malignancy in childhood
-Leukocoria, nystagmus, strabismus
-Ocular US = Mass
-Chemo, Radiation

Question 14

Argyll-Robertson Pupil

Answer 14

-Pupil constricts on accommodation but non-reactive to bright light
-Neurosyphilis

Question 15

Explain the location of the six EOM muscles and the actions of each

Answer 15

-MR: Adduction
-LR: Abduction
-SR: Elevation, Adduction, Intorsion
-IR: Depression, Adduction, Extorsion
-IO: Elevation, Abduction, Extorsion
-SO: Depression, Abduction, Intorsion