Eyes Flashcards
What most often causes central retinal artery occlusion (CRAO)?
Emolized plaque from ipsilateral carotid artery
Pale retina - due to ischemia and edema
Macular cherry-red spot (fovea thinnest here)
Flame-shaped hemorrhages
Hypertensive retinopathy
Obscured optic disc margins
Papilledema - increased ICP
Headache, nausea/vomiting
Visual function often normal
Glaucoma treatments
Bimatoprost - prostaglandin F2a analog increases uveoscleral outflow
Timolol - reduces aqueous production
Acetazolamide - rapidly reduce further production of aqueous humor
Apraclonidine - decreases aqueous production and increases outflow
If unresolved, use laser trabeculostomy, trabeculectomy, or trabecular shunt
Acute angle definitive treatment:
Laser iridotomy - facilitate aqueous outflow and provide definitive management
Use others and pilocarpine to manage until laser performed
Pilocarpine - cholinergic M3 agonist causes ciliary muscle contraction to open trabecular meshwork
Sympathetic ophthalmia - treatment
Corticosteroids, monoclonal biologics
Can try to prevent by removing damaged eye if no chance of recovery
Cause of fluffy, yellow-white exudates immediately adjacent to fovea and retinal vessels
CMV retinitis
Valganciclovir - both IV and intravitreal needed if lesions near fovea or optic nerve to prevent retinal scarring, blindness, and retinal detachment
Cause of branched linear lesions/keratitis under slit lamp examination
HSV keratitis
Also has clear, watery eye drainage
How is herpes simplex keratitis diagnosed?
Slit lamp
CMV vs HSV keratitis
CMV is painless; fluffy or granular retinal lesions near vasculature, as well as retinal hemorrhage
HSV has pain, dendritic ulcerations, normal fundoscopic exam
Central round infiltrate lesion of eye
Bacterial keratitis (e.g. Pseudomonas, S aureus) - typically due to contact lenses
Multiple ulcers with feathery margins
Candida keratitis - typically in immunocompromised after corneal trauma, particularly soil
More indolent than bacterial keratitis, but both have mucopurulent discharge
HIV retinopathy - appearance
Cotton-wool retinal lesions that are rarely hemorrhagic, without floaters or blurred vision
Vitreous hemorrhage requires what for diagnosis?
Dilated eye exam + slit lamp
What should be used in treatment of diabetic retinopathy but not wet age-related macular degeneration?
Laser photocoagulation - it would damage the retina
Instead, use intravitreal injections of VEGF inhibitors
Uveitis - signs
Moderate pain, blurred vision
Anterior chamber shows flare and cells on slit lamp exam
Pupil constricted with poor light response
Discharge/crusting of eyelashes, burning/itching of lids, foreign body sensation
Blepharitis - inflammation of the eyelid margin at opening of meibomian glands
Common causes of blepharitis
Seborrheic dermatitis
Rosacea
Allergic disorders
Bacterial infection (especially S aureus)
Viral (e.g. HSV)
Demodex mites
Wavy lines
Macular degeneration, more likely wet (exudative/neovascular)
Features of diabetic retinopathy
Microaneurysms (dot and blot hemorrhages when ruptured)
Macular edema (capillary leakage)
Hard exudates (insoluble lipids)
Cotton-wool spots (capillary leakage)
Macular cherry red spot (not congenital cause)
Central retinal artery occlusion
Would also have painless monocular vision loss
Nonspherical cornea
Astigmatism - blurry at any distance
CN V, X, XI, XII lesions - which side?
CN V: Jaw towards side of lesion (due to unopposed opposite pterygoid muscle)
CN X: Uvula away from lesion
CN XI: Weakness turning head away from lesion (SCM muscle); drooped shoulder (trapezius)
CN XII: Tongue towards side of lesion
Blown pupil suggests…
CN III compression ipsilaterally
- If due to uncal herniation - would also see contralateral hemiparesis that can progress to ipsilateral hemiparesis due to contralateral compression against Kernohan notch (Kernohan phenomenon)
- Could be due to posterior communicating artery aneurysm
