EYES

Question 1

What is Glaucoma and why is it dangerous?

Answer 1

Glaucoma is an eye condition where increased intraocular pressure (IOP) damages the optic nerve. It can lead to loss of peripheral vision, central vision loss, and ultimately blindness if untreated.

Mnemonic: “GLOP” – Glaucoma = Loss of Optic Pressure control.

Question 2

How is intraocular pressure (IOP) measured?

Answer 2

A tiny blast of air is used to measure corneal deflection and determine IOP. Normal range: 12-21 mmHg.

Mnemonic: “IOP 12 to 21” – Remember the time on a clock.

Question 3

What happens if the canal of Schlemm is blocked?

Answer 3

Aqueous humor can’t drain, increasing IOP and leading to optic nerve damage.

Visual Aid: Think of a blocked sink overflowing with water.

Question 4

Prevalence of Acute Angle-Closure Glaucoma in Canada

Answer 4

It is the 4th leading cause of blindness, affecting ~300,000 people.

Mnemonic: “4th for 300k.”

Question 5

Symptoms of Primary Open-Angle Glaucoma (POAG)

Answer 5

1. Gradual loss of peripheral vision (“tunnel vision”). 2. Often asymptomatic in early stages. 3. No pain or discomfort.

Mnemonic: “Silent Stealer” – steals vision silently.

Question 6

Symptoms of Acute Angle-Closure Glaucoma (AACG)

Answer 6

1. Severe eye pain. 2. Blurred vision with halos around lights. 3. Red eye with ciliary flush. 4. Fixed, mid-dilated pupil. 5. Headache, nausea, vomiting.

Mnemonic: “PAINFUL HALO” – Pain, Angle-closure, Increased IOP, Nausea, Fixed pupil, Unilateral, Light Halos.

Question 7

Symptoms of Normal-Tension Glaucoma (NTG)

Answer 7

1. Optic nerve damage despite normal IOP. 2. Often related to poor blood flow to optic nerve. 3. Slow progression similar to POAG.

Mnemonic: “Normal Pressure, Abnormal Damage.

Question 8

Pathophysiology of Glaucoma

Answer 8

1. Increased IOP → Increased vascular resistance. 2. Decreased blood flow to optic nerve = ischemia. 3. Light → Pupil dilation → Iris bows forward → Blocks drainage.

Mnemonic: “IVDIB” – Increased IOP, Vascular resistance, Decreased perfusion, Iris Bow.

Question 9

Risk Factors for Glaucoma

Answer 9

1. Narrow anterior chamber. 2. Prolonged darkness. 3. Pupil-dilating drugs (e.g., anticholinergics). 4. Age > 60. 5. African American heritage. 6. Family history. 7. Trauma or neoplasm. 8. Corticosteroid therapy. 9. Neovascularization. 10. Female sex.

Mnemonic: “N-PPAFT-CNF” – Narrow, Prolonged, Pupils, Age, Family, Trauma, Corticosteroid, Neovascularization, Female.

Question 10

Subjective Data to Gather for Glaucoma

Answer 10

1. When did symptoms start? One or both eyes? 2. Family history of glaucoma? 3. Recent eye trauma, herpes outbreak? 4. Any difficulty with peripheral vision, photophobia, or visual blurring? 5. In children, ask about eye rubbing, refusal to open eyes, tearing.

Mnemonic: “Onset, Vision, Family, Trauma.

Question 11

Key Physical Exam Findings in Glaucoma

Answer 11

1. Blood pressure check. 2. Inspect for redness, discharge, and inflammation. 3. Pupillary response to light. 4. Palpate globe (firmness). 5. Funduscopic exam (notching, cup-to-disc ratio).

Mnemonic: “BIPPF” – BP, Inspect, Pupils, Palpate, Fundus.

Question 12

Key Diagnostic Tests for Glaucoma

Answer 12

1. Visual acuity and peripheral vision. 2. Measure IOP with a tonometer. 3. Slit-lamp exam for corneal changes (oedematous or cloudy).

Mnemonic: “VIP” – Visual acuity, IOP, Peripheral fields.

Question 13

Differential Diagnoses for Glaucoma

Answer 13

1. Acute iritis. 2. Acute bacterial conjunctivitis. 3. Iridocyclitis. 4. Corneal injury. 5. Foreign body. 6. Herpetic keratitis.

Mnemonic: “ICICI” – Iritis, Conjunctivitis, Iridocyclitis, Cornea, Injury.

Question 14

Glaucoma Management Options

Answer 14

POAG: 1. Prostaglandin analogs (increase outflow). 2. Beta-blockers (reduce aqueous production). 3. Surgery if meds fail (trabeculectomy, shunt). AACG: 1. Acetazolamide IV, Mannitol (reduce IOP). 2. Topical beta-blockers. 3. Laser iridotomy for drainage.

Mnemonic: “GLASS” – Glaucoma Laser And Surgical Solutions.

Question 15

Complications of Untreated Glaucoma

Answer 15

Blindness

Question 16

Prostaglandin analogs (increase outflow)

Answer 16

Beta-blockers (reduce aqueous production)

Surgery if meds fail (trabeculectomy, shunt)

Question 17

AACG treatment

Answer 17

Acetazolamide IV, Mannitol (reduce IOP)

Topical beta-blockers, Laser iridotomy for drainage

Question 18

Complications of Untreated Glaucoma

Answer 18

Blindness, Loss of peripheral vision (‘tunnel vision’)

Severe vision loss in acute crisis

Question 19

Red Flag Symptom for Emergency Referral

Answer 19

Sudden severe eye pain, often with headache and nausea

Immediate emergency referral

Question 20

Referral Criteria for Glaucoma

Answer 20

Immediate for IOP measurement and acute management

Annual follow-up to monitor IOP, Possible surgical intervention (laser peripheral iridectomy)

Question 21

Canal of Schlemm

Answer 21

A circular channel in the eye that collects aqueous humor from the anterior chamber and drains it into the bloodstream

Blockage leads to increased IOP

Question 22

Prostaglandin Analogs in Glaucoma

Answer 22

They increase the outflow of aqueous humor, reducing IOP

Examples: Latanoprost, Bimatoprost

Question 23

Importance of IOP Measurement

Answer 23

Elevated IOP is the primary risk factor for optic nerve damage

Normal range: 10-21 mmHg

Question 24

What is Hordeolum (Stye)?

Answer 24

A painful, red, swollen bump on the eyelid, caused by a bacterial infection (usually Staphylococcus aureus) of the oil glands in the eyelid. It affects either the hair follicle or the associated glands (Zeis or Moll).

Example sentence: The patient presented with a Hordeolum on their upper eyelid.

Question 25

What are the types of Hordeolum?

Answer 25

1. External Hordeolum: Affects the glands near the eyelash base, causing a red bump on the outer eyelid.
2. Internal Hordeolum: Involves the meibomian glands inside the eyelid, leading to a deeper, painful swelling.

Mnemonic: “EXternal = Outside, INternal = Inside.”

Question 26

What causes Hordeolum?

Answer 26

Bacteria (Staphylococcus aureus) infect the oil glands in the eyelid (Zeis or Moll), causing a blocked gland and inflammation.

Mnemonic: “Staph attacks the glands.”

Question 27

What is the common history of Hordeolum?

Answer 27

Sudden onset of a painful, swollen, red bump on one eyelid. More common in children and people with previous eyelid issues.

Mnemonic: “One painful, swollen eyelid.”

Question 28

What are the risk factors for Hordeolum?

Answer 28

1. Children: Higher risk due to immature gland function.
2. Poor Hygiene: Not cleaning the eyelids or using old makeup.
3. Contact Lenses: Poor cleaning habits increase risk.
4. Blepharitis: Chronic eyelid inflammation increases susceptibility.

Mnemonic: “Kids, Cleanliness, Contacts, Chronic.”

Question 29

What are the common findings on physical exam for Hordeolum?

Answer 29

1. Tenderness: The eyelid is painful to touch.
2. Swelling and Redness: Localized to the affected area.
3. Pus Discharge: Sometimes, a small amount of pus may be visible.

Mnemonic: “Pain, Redness, Pus.”

Question 30

What subjective data should be gathered for Hordeolum?

Answer 30

1. When did it start?
2. Has this happened before?
3. Is there any change in vision?
4. How bad is the pain?
5. Any exposure to chemicals, or eye injuries?
6. Current medications and health conditions?

Mnemonic: “Start, Repeat, Sight, Pain, Cause, Meds.”

Question 31

What should be included in the physical examination for Hordeolum?

Answer 31

1. Inspect both eyes for redness, swelling, and discharge.
2. Turn the eyelid to check for any internal swelling.
3. Check for redness or abnormal areas on the white of the eye.
4. Feel around the eye for any swollen lymph nodes.

Mnemonic: “Look, Flip, Check, Feel.”

Question 32

What diagnostic tests are used for Hordeolum?

Answer 32

1. Visual Acuity: Check vision clarity.
2. Culture Test: Only if the stye keeps coming back.
3. Diabetes Screening: If there are repeated styes.

Mnemonic: “Vision, Bacteria, Blood Sugar.”

Question 33

What are the differential diagnoses for Hordeolum?

Answer 33

1. Chalazion: Painless, firm lump inside the eyelid.
2. Blepharitis: Red, crusty eyelids with no lump.
3. Xanthelasma: Yellowish lumps on the eyelids.
4. Conjunctivitis: Red, watery eyes without a painful bump.
5. Foreign Body: Irritation from something in the eye.

Mnemonic: “Chalazion, Blepharitis, Xanthelasma, Conjunctivitis, Foreign.”

Question 34

What are the red flags in Hordeolum that require immediate attention?

Answer 34

1. Sudden vision changes.
2. Severe pain not relieved by treatment.

Mnemonic: “Vision, Severe Pain.”

Question 35

When should a patient with Hordeolum be referred to an ophthalmologist?

Answer 35

1. If the infection spreads to the entire eyelid.
2. If the stye doesn’t improve with treatment.

Mnemonic: “Spreading or Stubborn.”

Question 36

What are the general interventions for managing Hordeolum?

Answer 36

1. Apply warm compresses 3-4 times a day.
2. Keep eyelids clean; use baby shampoo if needed.
3. Avoid touching or squeezing the stye.
4. Discard old makeup and use new, clean products.

Mnemonic: “Warm, Wash, Don’t Touch, Discard.”

Question 37

What is the role of pharmacological therapy in treating Hordeolum?

Answer 37

1. Often not needed; most styes heal on their own.
2. Use antibiotic ointments like erythromycin if necessary.
3. Oral antibiotics for severe cases or if infection spreads.

Mnemonic: “Wait, Ointment, Oral if severe.”

Question 38

Are non-prescription ophthalmic antibacterials recommended for Hordeolum?

Answer 38

No, most styes drain and heal on their own. Using over-the-counter drops is usually unnecessary.

Mnemonic: “Let it heal itself.”

Question 39

What is the first-line treatment for Hordeolum?

Answer 39

Use warm compresses to encourage drainage. If needed, a doctor may drain it and apply antibiotic ointment.

Mnemonic: “Compress First, Drain if Needed.”

Question 40

Are non-prescription ophthalmic antibacterials recommended for Hordeolum?

Answer 40

No, most styes drain and heal on their own. Using over-the-counter drops is usually unnecessary.

Mnemonic: “Let it heal itself.”

Question 41

What is the first-line treatment for Hordeolum?

Answer 41

Use warm compresses to encourage drainage. If needed, a doctor may drain it and apply antibiotic ointment.

Mnemonic: “Compress First, Drain if Needed.”

Question 42

What should clients be taught about Hordeolum management?

Answer 42

1. Don’t squeeze or pop the stye.
2. Throw away old eye makeup.
3. Keep eyelids clean to prevent recurrence.
4. Wash hands often to avoid spreading infection.

Mnemonic: “Don’t Pop, Discard, Clean, Wash Hands.”

Question 43

What are the recommended topical treatments for Hordeolum if needed?

Answer 43

1. Ophthalmic ointments: Polymyxin B sulfate and bacitracin zinc.
2. Erythromycin ointment: Applied to the conjunctival sac several times a day if incision and drainage are required.

Example sentence: Erythromycin ointment is commonly prescribed for Hordeolum.

Question 44

When should oral antibiotics like tetracycline be considered for Hordeolum?

Answer 44

For recurrent crops of styes that don’t respond to topical treatment. This helps reduce the risk of recurrence after consulting a physician.

Additional information: Oral antibiotics may be necessary in cases of persistent styes.

Question 45

Why is self-medication with non-prescription ophthalmic antibacterials not recommended for Hordeolum?

Answer 45

Most styes drain and heal spontaneously without medication, and self-medication can lead to unnecessary use of antibiotics.

Additional information: It is important to consult a healthcare professional before using any medication for Hordeolum.

Question 46

What is the role of pharmacological therapy after incision and drainage of a Hordeolum?

Answer 46

Ophthalmic antibacterial ointment, like erythromycin, should be applied to prevent further infection and promote healing.

Example sentence: After incision and drainage, pharmacological therapy helps in preventing secondary infections.

Question 47

What is iritis, and what are its key characteristics?

Answer 47

Iritis is inflammation of the iris, the colored part of the eye. It is a type of anterior uveitis causing pain, light sensitivity (photophobia), blurred vision, and a constricted or irregular pupil. If untreated, it can lead to serious complications like glaucoma and vision loss.

Example sentence: The patient presented with severe eye pain and photophobia, indicating possible iritis.

Question 48

What are the common causes and risk factors of iritis?

Answer 48

Causes: Autoimmune disorders (e.g., ankylosing spondylitis, reactive arthritis), infections (e.g., syphilis, HIV/AIDS), eye trauma, and genetic predisposition (HLA-B27).

Risk Factors:
1. HLA-B27 genetic alteration.
2. STIs like syphilis and HIV/AIDS.
3. Autoimmune conditions.
4. Smoking increases risk.

Additional information: Genetic predisposition to iritis is linked to the HLA-B27 gene.

Question 49

What are the typical symptoms of iritis?

Answer 49

Photophobia: Sensitivity to light.
Throbbing Eye Pain: Moderate to severe, usually in one eye.
Blurred Vision: Hazy or unclear vision.
Constricted or Irregular Pupil: Due to swelling of the iris.
Mnemonic: “Pain, Light, Blur, Pupil”.

Example sentence: The patient complained of severe eye pain and blurred vision, consistent with iritis.

Question 50

What are the main physical exam findings in iritis?

Answer 50

1. Ciliary Flush: Deep, dull red halo around the iris and cornea.
2. Pupil Changes: Smaller, irregular pupil due to iris inflammation.
3. Normal Cornea: Cornea remains clear.
4. Tearing: Watery eye without discharge.

Example sentence: The ciliary flush was evident during the physical exam, indicating possible iritis.

Question 51

What is the diagnostic approach for iritis, and what are the red flags?

Answer 51

Diagnostic Approach: Clinical diagnosis; immediate referral to an ophthalmologist. No specific diagnostic tests required.
Red Flags:
1. Extreme, unrelenting eye pain.
2. Decreased vision or sudden vision changes.

Additional information: Immediate referral is crucial in suspected cases of iritis to prevent complications.

Question 52

What are the common conditions to consider in the differential diagnosis of iritis?

Answer 52

1. Conjunctivitis: Red eye, often with discharge, no deep pain or photophobia.
2. Keratitis: Corneal inflammation, severe pain, vision changes.
3. Blepharitis: Inflammation of eyelid margins, no deep eye pain or photophobia.
4. Seasonal Allergies: Itchy, watery eyes, no pain or photophobia.

Additional information: Differential diagnosis helps distinguish iritis from similar eye conditions.

Question 53

What additional eye conditions should be considered in the differential diagnosis of iritis?

Answer 53

1. Glaucoma: High eye pressure, possible vision loss, no ciliary flush.
2. Hordeolum (Stye): Painful lump on the eyelid, not involving the eyeball.
3. Chalazion: Painless lump inside the eyelid.
4. Corneal Abrasion/Trauma: Often has a history of injury, sharp pain, and tearing.

Example sentence: The differential diagnosis ruled out glaucoma and stye in the patient presenting with eye pain.

Question 54

What are some less common conditions that should be differentiated from iritis?

Answer 54

1. Subconjunctival Hemorrhage: Painless red patch on the sclera, no pain or vision changes.
2. Inflamed Pterygium/Pinguecula: Localized conjunctival inflammation, no deep eye pain.

Additional information: Less common conditions may mimic iritis symptoms but require different management.

Question 55

What is the management approach for iritis, and when is referral necessary?

Answer 55

Management: Immediate referral to an ophthalmologist for diagnosis and treatment.
Referral: Necessary for all cases of iritis to prevent complications like glaucoma and permanent vision loss.

Example sentence: The patient was promptly referred to an ophthalmologist for iritis management.

Question 56

What complications can arise if iritis is left untreated?

Answer 56

1. Glaucoma: Increased eye pressure damaging the optic nerve.
2. Cataracts: Lens opacity due to prolonged inflammation or steroid use.
3. Posterior Synechiae: Iris and lens adhesions, causing vision issues.
4. Permanent Vision Loss: Due to damage from uncontrolled inflammation.

Additional information: Timely treatment can prevent serious complications associated with untreated iritis.

Question 57

What should patients be educated about regarding the prevention of iritis recurrence?

Answer 57

1. Adhere to Treatment: Follow the prescribed regimen to avoid complications.
2. Recognize Early Signs: Seek immediate help if symptoms like photophobia or eye pain recur.
3. Avoid Triggers: For those with autoimmune or recurrent iritis, avoid known triggers.
4. Quit Smoking: Reduces risk and severity of iritis.

Additional information: Patient education plays a crucial role in preventing iritis recurrence.

Question 58

What is the typical history of a foreign body in the ear?

Answer 58

Often, the patient or witness (in case of a child) reports a foreign object entering the ear.

Example sentence: The child complained of ear pain after putting a small toy in their ear.

Question 59

What are the symptoms of a foreign body in the ear?

Answer 59

Pain (dull or severe), feeling of fullness or pressure in the ear, and loss of hearing.

Additional information: Symptoms may vary depending on the size and type of foreign object.

Question 60

What are the signs of a foreign body in the ear during a physical exam?

Answer 60

Swelling, redness, otorrhea (discharge), and a foul smell.

Example sentence: The doctor observed redness and discharge in the ear upon examination.

Question 61

What are the symptoms of a foreign body in the eye?

Answer 61

Gritty sensation, pain, and scratchy sensation. History of recent injury or contact lens use.

Additional information: Contact lens wearers are at increased risk of foreign bodies in the eye.

Question 62

What are the symptoms of a foreign body in the nose?

Answer 62

Nasal discharge, epistaxis (nosebleed), nasal obstruction, and mouth breathing.

Example sentence: The patient presented with nosebleeds and difficulty breathing through the nose.

Question 63

What diagnostic test is used for foreign bodies in the ear, eye, or nose?

Answer 63

Visual inspection is the primary diagnostic approach. Do not attempt to remove foreign objects protruding from the eye; refer immediately.

Example sentence: The doctor used an otoscope to examine the ear for foreign bodies.

Question 64

What are the differential diagnoses for a foreign body in the eye?

Answer 64

Blepharitis, corneal abrasion, and conjunctivitis.

Additional information: Differential diagnoses help rule out other possible causes of eye symptoms.

Question 65

What are the differential diagnoses for a foreign body in the ear?

Answer 65

Cholesteatoma and acute otitis media with perforation.

Additional information: Cholesteatoma is a rare but serious condition that can mimic symptoms of a foreign body in the ear.

Question 66

What are the differential diagnoses for a foreign body in the nose?

Answer 66

Sinusitis, upper respiratory infection (URI), and allergic rhinitis.

Additional information: Allergic rhinitis can present with similar symptoms to a foreign body in the nose.

Question 67

Which population is most commonly affected by foreign bodies in the ear?

Answer 67

Foreign bodies in the ear canal occur more frequently in children than adults.

Additional information: Children are curious and may insert objects into their ears.

Question 68

What are the red flags for foreign bodies in the ear?

Answer 68

Sharp objects can perforate the eardrum, and organic objects may swell and occlude the canal.

Example sentence: Immediate medical attention is needed if a sharp object is suspected in the ear.

Question 69

What is a red flag for foreign bodies in the eye?

Answer 69

Do not remove objects protruding from the eye; refer immediately to prevent further damage.

Additional information: Removing objects from the eye without proper training can lead to complications.

Question 70

What are the red flags for foreign bodies in the nose?

Answer 70

Button batteries, magnets, or superabsorbent beads can cause severe tissue damage and warrant urgent removal.

Additional information: Ingestion or insertion of small objects in the nose can lead to serious complications.

Question 71

When is an otolaryngologist referral needed for ear foreign bodies?

Answer 71

Suspected penetration of the tympanic membrane with potential damage to middle ear structures. Symptoms such as ear pain, vertigo, nystagmus, ataxia, otorrhea, facial nerve paralysis, or hearing loss.

Additional information: Otolaryngologists specialize in ear, nose, and throat conditions.

Question 72

When is an otolaryngologist referral needed for nasal foreign bodies?

Answer 72

Posterior foreign bodies not readily visualized, impacted foreign bodies causing marked inflammation, button batteries, magnets, or superabsorbent beads that need urgent removal, and penetrating or hooked foreign bodies.

Additional information: Urgent referrals are necessary for certain types of nasal foreign bodies to prevent complications.

Question 73

How should ear foreign bodies be managed in children?

Answer 73

Avoid using Q-tips or inserting objects in the ear, seek medical help if an ear foreign body is suspected, and supervise children during play with small objects.

Additional information: Prevention is key to avoiding ear foreign bodies in children.

Question 74

What are the potential complications of ear foreign bodies?

Answer 74

Perforation of the tympanic membrane, infection spreading to the middle ear, and hearing loss if left untreated.

Additional information: Complications can arise if ear foreign bodies are not promptly addressed.

Question 75

What are the potential complications of nasal foreign bodies?

Answer 75

Severe nasal obstruction leading to breathing difficulties, tissue necrosis if button batteries or magnets are involved, and infection spreading to adjacent structures.

Additional information: Prompt removal of nasal foreign bodies is crucial to prevent serious complications.

Question 76

What is diabetic retinopathy?

Answer 76

Diabetic retinopathy is a retinovascular disease caused by damage to the blood vessels in the retina due to high blood sugar levels in diabetes. It leads to vision problems and occurs in two forms.

Example sentence: Diabetic retinopathy is the leading cause of blindness in working-age adults.

Question 77

What are the two forms of diabetic retinopathy?

Answer 77

1. Nonproliferative Retinopathy: Characterized by microaneurysms, macular edema, lipid exudates, and intraretinal hemorrhages.
2. Proliferative Retinopathy: Involves the growth of new, abnormal blood vessels on the retina, which can lead to severe vision loss.

Example sentence: Nonproliferative retinopathy is often asymptomatic until it progresses to more severe stages.

Question 78

What is the typical patient history for diabetic retinopathy?

Answer 78

Gradual bilateral vision loss that progresses over time. The patient may initially be asymptomatic or notice decreased vision or floaters as the disease worsens.

Example sentence: Patients with diabetic retinopathy may report a gradual decline in vision quality.

Question 79

What are the primary risk factors for developing and progressing diabetic retinopathy?

Answer 79

1. Duration of Diabetes: Longer duration increases the risk.
2. Glycemic Control: Poor blood sugar control accelerates progression.

Example sentence: Patients with poorly controlled diabetes are at a higher risk of developing diabetic retinopathy.

Question 80

What additional factors increase the risk of diabetic retinopathy?

Answer 80

1. Hypertension: High blood pressure worsens damage to retinal blood vessels.
2. Other Microvascular Complications: Includes diabetic nephropathy and neuropathy.
3. Dyslipidemia: Abnormal cholesterol and triglyceride levels.
4. Pregnancy: Temporarily increases the risk and progression due to hormonal changes and fluctuating blood sugar levels.

Example sentence: Patients with hypertension should be closely monitored for diabetic retinopathy.

Question 81

What are the common symptoms of diabetic retinopathy?

Answer 81

1. Gradually worsening vision.
2. Sudden vision loss.
3. Shapes floating in the field of vision (floaters).
4. Blurred or patchy vision.
5. Eye pain or redness.

Example sentence: Blurred vision is a common symptom of diabetic retinopathy.

Question 82

What are the screening guidelines for type 1 diabetes?

Answer 82

Screen annually starting 5 years after the onset of diabetes, usually at or after age 15. Early screening can help detect changes before severe damage occurs.

Example sentence: Type 1 diabetes patients should undergo regular eye screenings to monitor for diabetic retinopathy.

Question 83

What are the screening guidelines for type 2 diabetes?

Answer 83

Screen at the time of diagnosis for all patients, including children and adolescents. Follow-up screenings every 1-2 years, or more frequently if severity dictates.

Example sentence: Type 2 diabetes patients should have their eyes checked regularly to detect any signs of diabetic retinopathy.

Question 84

How should diabetic retinopathy be managed during pregnancy?

Answer 84

Pre-Pregnancy: Evaluate patients during pregnancy planning.
During Pregnancy: Screen in the first trimester and monitor as needed throughout pregnancy.
Postpartum: Screen again within the first year after giving birth.

Example sentence: Pregnant women with diabetes need specialized care to manage diabetic retinopathy.

Question 85

What is the primary diagnostic test for diabetic retinopathy?

Answer 85

A dilated eye exam allows a detailed view of the retina to check for microaneurysms, hemorrhages, and abnormal blood vessel growth.

Example sentence: A dilated eye exam is essential for diagnosing diabetic retinopathy.

Question 86

What conditions should be considered in the differential diagnosis of diabetic retinopathy?

Answer 86

1. Corneal Abnormalities: Issues like corneal scarring or dystrophy.
2. Glaucoma: Increased intraocular pressure that damages the optic nerve.
3. Cataracts: Clouding of the lens, causing blurry vision.

Example sentence: Differential diagnosis of diabetic retinopathy involves ruling out other eye conditions.

Question 87

Why is diabetic retinopathy a significant global concern?

Answer 87

It is one of the leading causes of vision loss worldwide and the principal cause of impaired vision in patients between 25 and 74 years old, significantly impacting quality of life.

Example sentence: Diabetic retinopathy poses a major public health challenge globally.

Question 88

What are the red flags indicating severe diabetic retinopathy?

Answer 88

1. Sudden vision loss.
2. New or worsening floaters.
3. Significant vision changes.
4. Flashes of light or a shadow over the visual field, which may indicate retinal detachment.

Example sentence: Severe diabetic retinopathy requires immediate medical attention.

Question 89

When should patients with diabetic retinopathy be referred to a specialist?

Answer 89

Patients should be referred to an optometrist or ophthalmologist for:
1. Regular screening every 1-2 years.
2. Immediate referral if experiencing sudden vision loss, severe symptoms, or advanced retinopathy.

Example sentence: Referral to a specialist is crucial for managing diabetic retinopathy.

Question 90

How does good glycemic control affect diabetic retinopathy?

Answer 90

Maintaining good blood sugar control can slow the onset and progression of diabetic retinopathy, reducing the risk of severe complications.

Example sentence: Proper glycemic control plays a key role in managing diabetic retinopathy.

Question 91

How do hypertension and dyslipidemia impact diabetic retinopathy?

Answer 91

Hypertension: Increases damage to retinal blood vessels, worsening the condition.
Dyslipidemia: Abnormal cholesterol levels increase the risk of retinal damage.

Example sentence: Hypertension and dyslipidemia are important risk factors for diabetic retinopathy.

Question 92

How does pregnancy affect diabetic retinopathy?

Answer 92

Pregnancy can temporarily increase the risk and progression of diabetic retinopathy due to hormonal changes and fluctuations in blood sugar levels, requiring closer monitoring.

Example sentence: Pregnant women with diabetes need specialized care to manage diabetic retinopathy.

Question 93

What is a chalazion?

Answer 93

A chalazion is a chronic inflammation of a meibomian gland in the eyelid due to blocked ducts, resulting in a painless nodule.

Example sentence: She was diagnosed with a chalazion after noticing a small nodule on her eyelid.

Question 94

What causes a chalazion?

Answer 94

It is caused by the occlusion of the meibomian gland ducts, leading to lipogranulomatous inflammation.

No additional information.

Question 95

What are the common symptoms of a chalazion?

Answer 95

Swelling on the eyelid.
Nontender, hard, pea-sized nodule inside the lid margin.
Discomfort or irritation, but usually no pain.

No additional information.

Question 96

What should you assess in the history for a chalazion?

Answer 96

Onset, course, and duration of symptoms.
Visual disturbances (blurred or loss of vision).
History of eye trauma or foreign body.
Pain or tenderness in the eyelid.
Past eye problems and treatments.
Use of contact lenses or glasses and duration.
Previous self-treatment attempts.

No additional information.

Question 97

What are the key findings on physical exam for a chalazion?

Answer 97

Inspect for foreign bodies and subconjunctival mass.
Palpate for a hard, nontender nodule on the tarsus, away from the lid margin.
Check for preauricular adenopathy.
Differentiate from hordeolum (stye), which is painful and on the lid margin.

No additional information.

Question 98

What are the main differential diagnoses for a chalazion, and why?

Answer 98

Chronic Dacryocystitis: Inflammation of the lacrimal sac, usually with pain and swelling near the inner corner of the eye.
Hordeolum (Stye): Acute, painful infection of a sebaceous gland on the lid margin, often confused with chalazion but tender to touch.
Blepharitis: Chronic inflammation of the eyelid margins with itching and redness, often leading to recurrent chalazia.
Xanthelasma: Yellowish cholesterol deposits on the eyelids, which appear as raised plaques but are not related to meibomian glands.
Cellulitis of the Eyelid: Diffuse redness, warmth, and swelling of the eyelid, often with systemic symptoms like fever, requiring urgent treatment.

No additional information.

Question 99

What is the key diagnostic test for a chalazion?

Answer 99

A visual acuity examination to assess for vision impact and complications like astigmatism.

No additional information.

Question 100

What are the red flags that require immediate referral for a chalazion?

Answer 100

Large, central, or deep lesions affecting vision.
Persistent symptoms after 48 hours of treatment.
Signs of infection or cellulitis.

No additional information.

Question 101

What are the treatment options for a chalazion?

Answer 101

Warm compresses to promote drainage.
Avoid self-medication with antibiotics.
For large chalazia: intralesional steroid injection or surgical excision by an ophthalmologist.

No additional information.

Question 102

What is the follow-up protocol for a chalazion?

Answer 102

Re-evaluate within 24 hours.
Continue ointment or drops for 4 days after resolution.
Refer to ophthalmologist if symptoms persist beyond 48 hours.

No additional information.

Question 103

What is a corneal abrasion?

Answer 103

A corneal abrasion is the loss of the corneal epithelial tissue, either superficial or deep, usually due to trauma or injury to the eye.

Example sentence: The patient presented with a corneal abrasion after being hit in the eye with a tree branch.

Question 104

What are the common causes of corneal abrasions?

Answer 104

Common causes of corneal abrasions include direct trauma (e.g., fingernail scratch, foreign body), improper use of contact lenses, chemical exposure, and accidental rubbing of the eye.

Example sentence: The patient developed a corneal abrasion after getting a chemical in their eye while cleaning.

Question 105

What are the typical symptoms of a corneal abrasion?

Answer 105

Typical symptoms of a corneal abrasion include sudden onset of sharp eye pain, foreign-body sensation in the eye, watery eye (tearing), mild photophobia (light sensitivity), blurred vision, and headache.

Example sentence: The patient complained of sharp eye pain and blurred vision, indicating a possible corneal abrasion.

Question 106

What should be included in the patient history for a corneal abrasion?

Answer 106

Patient history for a corneal abrasion should include onset, duration, and course of symptoms, mechanism of injury, visual changes, occupation, sports or activities involving eye exposure, use of protective eyewear, history of eye infections, and use of contact lenses.

Example sentence: During the patient history, it was revealed that the individual had a history of recurrent corneal erosions.

Question 107

What should be assessed in the physical exam for a corneal abrasion?

Answer 107

In the physical exam for a corneal abrasion, inspect the eye for signs of trauma, redness, or foreign body, check for conjunctival discharge, perform a fluorescein stain test, evaluate visual acuity, and check for associated symptoms like headache, photophobia, redness, itching, or tearing.

Example sentence: The physician conducted a physical exam and performed a fluorescein stain test to confirm the presence of a corneal abrasion.

Question 108

What is the key diagnostic test for a corneal abrasion?

Answer 108

The key diagnostic test for a corneal abrasion is the fluorescein stain test. The presence of an epithelial defect that stains with fluorescein dye indicates a corneal abrasion.

Example sentence: The fluorescein stain test confirmed the diagnosis of a corneal abrasion in the patient.

Question 109

Why are the following conditions considered differential diagnoses for a corneal abrasion?

Answer 109

Why are the following conditions considered differential diagnoses for a chalazion?

1.	Chronic Dacryocystitis: This condition involves inflammation of the lacrimal sac, presenting with pain, swelling, and tenderness near the inner corner of the eye. It can be confused with a chalazion due to its location and swelling near the eye, but differs in tenderness and systemic symptoms.
2.	Hordeolum (Stye): A stye is an acute, painful infection of a sebaceous gland on the lid margin. It is often confused with a chalazion due to similar location and appearance, but styes are typically tender and painful, unlike the painless chalazion.
3.	Blepharitis: Chronic inflammation of the eyelid margins often leads to recurrent chalazia. It presents with redness, irritation, and crusting at the lid margins, and can cause similar symptoms of discomfort and swelling as a chalazion.
4.	Xanthelasma: These are yellowish cholesterol deposits on the eyelids, presenting as raised plaques. Although they share a similar location with chalazia, they are not related to the meibomian glands and do not cause inflammation or tenderness.
5.	Cellulitis of the Eyelid: This is a diffuse bacterial infection of the eyelid tissue, presenting with redness, warmth, and swelling, often with fever and systemic symptoms. It can be mistaken for a severe chalazion, but cellulitis is more widespread and accompanied by systemic signs.

Question 110

What is the epidemiology of corneal abrasions?

Answer 110

Approximately 2.4 million eye injuries occur annually in the United States, with corneal abrasions accounting for about 10% of new admissions to eye emergency units.

Example sentence: The epidemiology report highlighted the significant number of corneal abrasions in emergency eye units.

Question 111

What are the red flags that indicate the need for immediate referral for a corneal abrasion?

Answer 111

Red flags that indicate the need for immediate referral for a corneal abrasion include large or central lesions risking scarring, deep or penetrating wounds, persistent symptoms beyond 48 hours, and signs of infection.

Example sentence: The patient was immediately referred for further evaluation due to the presence of red flags like deep corneal wounds and persistent symptoms.

Question 112

Why are oral antivirals used as the first-line treatment for HZO?

Answer 112

Oral antivirals, such as famciclovir and valacyclovir, are used to reduce viral replication, decrease the severity and duration of the rash, and lower the risk of complications, including postherpetic neuralgia and ocular involvement.

Question 113

When should you refer a patient with Herpes Zoster Ophthalmicus to an ophthalmologist?

Answer 113

Referral to an ophthalmologist is indicated if there is:

1.	Eye Involvement: Any signs of conjunctivitis, keratitis, uveitis, or visual disturbances.
2.	Nasociliary Involvement: Presence of Hutchinson’s sign (lesions on the tip or side of the nose), indicating a higher risk of ocular complications.
3.	Persistent Symptoms: Ongoing pain or rash despite antiviral treatment.

Question 114

What are the red flags for urgent referral in Herpes Zoster Ophthalmicus?

Answer 114

1. Severe eye pain, redness, or decreased vision.
   
   2. Vesicular rash involving the tip of the nose (Hutchinson’s sign).
   3. Symptoms suggestive of optic neuritis, such as sudden vision loss or eye pain with movement.
   4. Signs of orbital cellulitis (swelling, redness, and pain around the eye).

Question 115

How does Herpes Zoster Ophthalmicus differ from Herpes Simplex Keratitis?

Answer 115

• HZO: Involves reactivation of the varicella-zoster virus and typically affects the V1 dermatome with a painful rash. It can lead to severe ocular complications like uveitis and keratitis.
• Herpes Simplex Keratitis: Caused by herpes simplex virus (HSV-1) and usually presents with dendritic corneal ulcers, without the characteristic vesicular rash of HZO.

Question 116

What preventive measures can be taken for Herpes Zoster Ophthalmicus?

Answer 116

1. Zoster Vaccine (Shingrix): Recommended for individuals over 50 years to reduce the risk of shingles and postherpetic neuralgia.
   
   2. Management of Immunosuppressive Conditions: Monitoring and adjusting immunosuppressive therapy to minimize the risk of reactivation.
   3. Prompt Antiviral Treatment: Early initiation of antiviral therapy at the onset of symptoms can reduce severity and complications.

Question 117

What is the role of corticosteroids in the management of Herpes Zoster Ophthalmicus?

Answer 117

Topical or systemic corticosteroids may be used in conjunction with antivirals to reduce inflammation in cases of severe keratitis, uveitis, or scleritis, but only under close supervision by an ophthalmologist to prevent worsening of viral replication.

Question 118

What is postherpetic neuralgia, and how is it related to HZO?

Answer 118

Postherpetic neuralgia (PHN) is a complication of HZO characterized by persistent pain in the affected dermatome after the rash has healed. It results from nerve damage caused by the viral infection and can be severe and long-lasting, impacting quality of life.

Question 119

What are the treatment options for postherpetic neuralgia in HZO?

Answer 119

1. Oral Antiviral Therapy: To reduce the risk of developing PHN.
   
   2. Analgesics: Such as acetaminophen or NSAIDs for pain relief.
   3. Antidepressants (e.g., amitriptyline): For neuropathic pain.
   4. Anticonvulsants (e.g., gabapentin): To reduce nerve pain.
   5. Topical Lidocaine Patches: For localized pain relief.

Question 120

What is Herpes Zoster Ophthalmicus (HZO)?

Answer 120

Herpes Zoster Ophthalmicus (HZO) is a viral infection caused by the reactivation of the varicella-zoster virus, affecting the ophthalmic branch (V1) of the fifth cranial nerve (trigeminal nerve), leading to a painful, unilateral rash and potential eye complications.

Question 121

What are the typical symptoms of Herpes Zoster Ophthalmicus (HZO)?

Answer 121

• Painful, burning rash along the distribution of the trigeminal nerve (V1).
• Vesicular lesions on the forehead, eyelid, and tip of the nose (Hutchinson’s sign).
• Eye involvement can include redness, pain, and sensitivity to light.
• Possible vision changes, such as blurred vision or loss of visual acuity.

Question 122

What is the significance of Hutchinson’s sign in HZO?

Answer 122

Hutchinson’s sign is the presence of vesicular lesions on the tip or side of the nose. It indicates nasociliary nerve involvement and a higher risk of ocular complications in HZO.

Question 123

What are the risk factors for developing Herpes Zoster Ophthalmicus?

Answer 123

1. Advanced age (typically over 50 years).
   
   2. Immunocompromised state (HIV, chemotherapy, or immunosuppressive therapy).
   3. History of chickenpox or previous varicella-zoster virus infection.
   4. Stress or trauma, which can trigger reactivation of the virus.

Question 124

What are the potential complications of Herpes Zoster Ophthalmicus?

Answer 124

1. Keratitis: Inflammation of the cornea, leading to scarring and vision loss.
   
   2. Uveitis: Inflammation of the middle layer of the eye, causing pain and redness.
   3. Glaucoma: Increased intraocular pressure due to uveitis or trabeculitis.
   4. Optic Neuritis: Inflammation of the optic nerve, potentially leading to vision loss.
   5. Postherpetic Neuralgia: Persistent pain in the affected area after the rash has healed.

Question 125

What is the first-line oral treatment for Herpes Zoster Ophthalmicus in adults?

Answer 125

1. Famciclovir 500 mg TID for 7-10 days.
   
   2. Valacyclovir 1 g TID for 7-10 days.
      These antiviral medications help to reduce the severity and duration of the infection.

Question 126

What is Dry Eye Disease (DED)?

Answer 126

Dry Eye Disease (DED) is a chronic condition characterized by insufficient tear production or increased tear evaporation, leading to inflammation and damage to the ocular surface, resulting in discomfort and visual disturbance.

Question 127

What are the primary causes of Dry Eye Disease?

Answer 127

1) Decreased Tear Production: Often due to aging, certain medications (antihistamines, beta-blockers), or autoimmune diseases like Sjögren’s syndrome.

2) Increased Tear Evaporation: Caused by factors such as low humidity environments, prolonged screen use, and eyelid disorders like meibomian gland dysfunction.

3) Imbalance in Tear Composition: Disruption in the balance of water, mucus, and oil in the tear film.

Question 128

What are the common symptoms of Dry Eye Disease?

Answer 128

*Sensation of dryness, grittiness, or burning in the eyes.

*Blurred vision that often improves with blinking.

*Increased tear production as a reflex to dryness (paradoxical tearing).

*Eye redness and sensitivity to light (photophobia).

*Difficulty wearing contact lenses or performing tasks like reading or using a computer for long periods.

Question 129

What is the first-line treatment for mild Dry Eye Disease?

Answer 129

Ocular Lubricants (Artificial Tears): These are used to supplement the natural tear film and provide temporary relief from dryness and irritation.

Example: Systane Gel: Apply to lower eyelid 3-4 times a day (TID-QID).

Question 130

What treatments are recommended for moderate to severe Dry Eye Disease?

Answer 130

Ophthalmic Corticosteroids: Reduce inflammation on the ocular surface.

–Fluorometholone: 1-2 drops BID to QID for 2-4 weeks.
–Loteprednol 0.5%: 1-2 drops QID for 2-4 weeks.

Cyclosporine Ophthalmic Solution: Immunomodulatory agent that reduces ocular surface inflammation.
–Dosage: 1 drop BID.

Lifitegrast Ophthalmic Solution: Lymphocyte function-associated antigen-1 (LFA-1) antagonist that reduces T-cell mediated inflammation.
–Dosage: 1 drop BID.

Question 131

How do artificial tears work in treating Dry Eye Disease?

Answer 131

Artificial tears replace or supplement the natural tear film but do not target the underlying cause of Dry Eye Disease. They provide temporary relief by lubricating the eye and reducing symptoms of dryness and irritation.

Question 132

What is the role of cyclosporine in treating Dry Eye Disease?

Answer 132

Cyclosporine is an immunosuppressive agent that reduces inflammation and helps increase tear production by suppressing the local immune response in the lacrimal gland and ocular surface.

Question 133

How do ophthalmic corticosteroids help in managing Dry Eye Disease?

Answer 133

Ophthalmic corticosteroids, such as fluorometholone and loteprednol, reduce ocular surface inflammation. They are used short-term to manage moderate to severe symptoms and are tapered off to prevent side effects like increased intraocular pressure or cataract formation.

Question 134

What are the potential side effects of using ophthalmic corticosteroids?

Answer 134

1) Increased Intraocular Pressure: Prolonged use can lead to glaucoma.

2) Cataract Formation: Long-term use increases the risk.

3) Secondary Infections: Corticosteroids can suppress the immune response, increasing susceptibility to infections.

Question 135

What is Lifitegrast, and how does it work in treating Dry Eye Disease?

Answer 135

Lifitegrast is an LFA-1 antagonist that works by inhibiting the interaction between T-cells and the ocular surface, reducing inflammation and improving symptoms in moderate to severe Dry Eye Disease. Dosage: 1 drop BID.

Question 136

What lifestyle modifications can help manage Dry Eye Disease?

Answer 136

1) Environmental Changes: Use a humidifier in dry environments and avoid direct exposure to fans or air conditioning.

2) Screen Time Management: Take regular breaks during prolonged screen use to reduce eye strain and dryness.

3) Eyelid Hygiene: Regular cleaning of eyelids with warm compresses to help unblock meibomian glands.

4) Blinking Exercises: Encourage complete blinking to spread tears evenly across the ocular surface

Question 137

What are some complementary therapies for managing Dry Eye Disease?

Answer 137

1) Omega-3 Fatty Acid Supplements: May improve tear film stability and reduce inflammation.

2) Warm Compresses: Applied to the eyelids to help unblock meibomian glands.

3) Punctal Plugs: Small devices inserted into the tear ducts to prevent tear drainage and increase moisture on the ocular surface.

Question 138

When should a patient with Dry Eye Disease be referred to an ophthalmologist?

Answer 138

1) When symptoms do not improve with first-line treatments like artificial tears.

2) If there are signs of ocular surface damage or secondary infection.

3) For advanced treatments such as punctal plugs or prescription medications like cyclosporine or lifitegrast.

Question 139

What are the complications of untreated Dry Eye Disease?

Answer 139

1) Chronic Discomfort: Persistent irritation and discomfort affecting quality of life.

2) Ocular Surface Damage: Including corneal ulcers or keratitis.

3) Impaired Vision: Due to corneal damage or irregularities.

4) Increased Risk of Infection: Due to compromised tear film and ocular surface integrity.

Question 140

What is blepharitis?

Answer 140

Blepharitis is an inflammation of the eyelid margins, often appearing as red, scaly, greasy flakes with crusted lid margins. It can be caused by seborrheic dermatitis or a staphylococcal infection at the lid edge.

Question 141

What are the two main types of blepharitis, and what causes them?

Answer 141

1) Seborrheic Blepharitis: Caused by excessive shedding of skin cells and blockage of glands, often associated with seborrheic dermatitis.

2) Staphylococcal Blepharitis: Caused by colonization of the eyelid edge with Staphylococcus bacteria, leading to infection and inflammation.

Question 142

What are common symptoms and physical exam findings in blepharitis?

Answer 142

**Symptoms: Burning and itching, tearing, photophobia (sensitivity to light), dry eyes, and recurrent styes or chalazia.

**Physical Exam:
**Redness, swelling, and erythema of the eyelid margins.
**Dry, flaky secretions on the lid margins and eyelashes.
**Presence of greasy scales or crusts on the eyelids.
**Possible dry eyes and signs of inflammation around the eyes.

Question 143

What are the risk factors and predisposing conditions for blepharitis?

Answer 143

Diabetes: Increases susceptibility to infections.

Candida: Fungal infections can worsen inflammation.

Seborrheic Dermatitis: Associated with excessive skin cell shedding.

Acne Rosacea: Chronic skin condition that can affect the eyelids.

Question 144

What should be included in the history and subjective assessment for blepharitis?

Answer 144

Onset and duration of symptoms.
Presence of itching, burning, or pain in the eye.

Factors that make symptoms worse or better.

Recent changes in personal care products like soaps, creams, or shampoos.

History of similar symptoms or episodes in the past.

Any changes in vision or new eye pain since the last eye exam.

Contributing factors such as allergies, environmental irritants, or contact lens use.

Question 145

What should be assessed during the physical examination for blepharitis?

Answer 145

Inspect for erythema, edema, dryness, and scaling of the lid margins.

Examine the eyes for red reflex and check sclera, pupil, and iris for abnormalities.

Assess visual acuity using the Snellen chart for children older than 3 years.

Observe extraocular movements (EOMs) and check for any limitations.

Note any crusting or flaking on the eyelashes and lid margins.

Question 146

What are the differential diagnoses for blepharitis?

Answer 146

Conjunctivitis: Inflammation of the conjunctiva with discharge and redness.

Eyelid Malignancy: Persistent lumps or lesions on the eyelid that do not resolve.

Hordeolum (Stye) or Chalazion: Localized swelling on the eyelid, often painful and red.

Meibomian Gland Dysfunction: Blocked oil glands causing dry eyes and inflammation.

Upper Respiratory Infection or Sinusitis: Can cause referred pain and inflammation near the eyes.

Question 147

Why is blepharitis considered a common eye condition?

Answer 147

Blepharitis is one of the most frequently encountered ocular conditions, especially in individuals with chronic skin conditions like seborrheic dermatitis or acne rosacea. It can be recurrent and persistent.

Question 148

When should a patient with blepharitis be referred to a specialist?

Answer 148

For recurrent or severe episodes that do not respond to initial treatment.

When there is associated visual impairment or suspicion of complications like meibomian gland dysfunction.

If there is a potential secondary infection or development of styes/chalazia.

Question 149

What are the complementary therapies for managing blepharitis?

Answer 149

1) Lid Hygiene: Clean the lid margins with a warm washcloth and baby shampoo BID-TID until improved, then once daily for maintenance.

2) Artificial Tears: To alleviate dry eyes and improve comfort.

3) Anti-Seborrheic Shampoos: For patients with seborrhea of the scalp, use these shampoos to reduce skin shedding and inflammation.

Question 150

What are the first-line drugs for blepharitis, and when are they used?

Answer 150

1) Lid Hygiene: Primary treatment for all types of blepharitis.

2) Erythromycin 0.5% Ointment: ½ inch applied to the lid margins QHS (first-line for bacterial or mixed types).

3) Tobramycin 0.3% Ointment: ½ inch applied to the lid margins QHS, especially in cases with mixed seborrheic and bacterial causes or meibomian gland dysfunction.

Question 151

How does inadequate flow of oil and mucus contribute to blepharitis?

Answer 151

Blockage of the meibomian glands can prevent the proper flow of oil and mucus into the tear duct, leading to dry eyes, inflammation, and increased risk of bacterial colonization, which can exacerbate blepharitis.

Question 152

What lifestyle and preventive measures can help manage and prevent blepharitis?

Answer 152

1) Regular Lid Hygiene: Clean eyelids regularly to remove debris and prevent blockages.

2) Manage Underlying Conditions: Treat seborrheic dermatitis or acne rosacea effectively.

3) Avoid Irritants: Use hypoallergenic products and avoid eye makeup if it triggers symptoms.

4) Maintain Good Hand Hygiene: To prevent bacterial contamination of the eyelids.

Question 153

What is a cataract?

Answer 153

A cataract is a condition where the lens of the eye loses its transparency, becoming cloudy or opaque, leading to decreased vision. It often appears as a pearly gray area in the lens.

Question 154

What are the common causes of cataracts?

Answer 154

1) Age-Related (Senile Cataracts): The most common type, associated with aging.

2) Drug Reactions: Prolonged use of steroids or certain medications.

3) Injuries: Trauma to the eye can cause cataract formation.

4) Radiation Exposure: UV radiation or radiation therapy to the head or neck.

Question 155

What are the common symptoms of cataracts?

Answer 155

**Decreased vision.

**Blurred or foggy vision, sometimes described as “ghost” images.

**Difficulty driving at night due to glare from headlights.

**Altered color perception, with colors appearing faded or yellowed.

Frequent changes in eyeglass prescriptions.

Frequent falls or injuries due to impaired vision.

Question 156

What should be assessed in the patient history for cataracts?

Answer 156

1) Onset, course, and duration of visual changes.

2) Impact on day and night vision, as well as near and far sight.

3) Which eye is affected or if both eyes are involved.

4) Use of glasses or extra light to improve vision.

5) Medical history, including use of medications like steroids.

6) History of traumatic injury to the eyes.

7) Exposure to UV rays through occupation or leisure activities.

Question 157

What should be checked during a physical exam for cataracts?

Answer 157

Visual Acuity Test: To assess the extent of vision impairment.

Funduscopic Exam:
**Check for the red reflex: A normal eye shows a bright red reflex, while a cataract disrupts this reflex, appearing as dark areas against the red-orange reflex.
**Assess lens opacities and note any dark areas.
***Look for the color of the opacity:
Brunescent cataracts have a yellow-brown hue.

Peripheral Vision Test: To evaluate the impact on overall vision.

Check for Retinal Abnormalities: Look for hemorrhage, scarring, and drusen.

Question 158

What are the key differential diagnoses for cataracts?

Answer 158

Glaucoma: Increased intraocular pressure with potential optic nerve damage, which can cause vision loss but usually starts with peripheral vision loss.

Age-Related Macular Degeneration (AMD): Loss of central vision due to retinal damage, similar to cataracts but typically starts with blurring of central vision.

Diabetic Retinopathy: Vision loss due to damage to the blood vessels in the retina, often with retinal hemorrhages and microaneurysms.

Temporal Arteritis: Inflammation of the temporal arteries, leading to sudden vision loss, headache, and jaw claudication.

Question 159

What is the epidemiology of cataracts?

Answer 159

Cataracts are the most common cause of blindness in the world.

Question 160

What are the red flags indicating the need for cataract surgery?

Answer 160

Visual disturbance is interfering with daily life, such as causing falls, difficulty reading, or inability to drive safely.

Significant glare or halos around lights, especially at night.

Difficulty performing activities that require clear vision, such as watching TV or recognizing faces.

Question 161

When should a patient with cataracts be referred for ophthalmologic consultation?

Answer 161

If the cataract is causing significant visual impairment.

For monitoring by an ophthalmologist to assess the progression and need for surgical intervention.

If there are associated symptoms like frequent falls, indicating severe vision impairment.

To connect with social workers or community resources for support and assistance with daily activities.

Question 162

What are the treatment options for cataracts?

Answer 162

Non-Surgical Management:
**Use of stronger lighting and magnifying lenses.
**Updating eyeglass prescriptions frequently as the condition progresses.

Surgical Management:
**Cataract Surgery: Removal of the cloudy lens and replacement with a synthetic intraocular lens (IOL).
**Surgery is recommended when visual impairment interferes with daily activities.

Question 163

Why is chronological age not a deterrent for cataract surgery?

Answer 163

Surgery should be based on the level of visual impairment and the impact on quality of life, not just age.

Elderly patients can greatly benefit from cataract surgery, which can significantly improve vision and quality of life, allowing them to remain independent.

Question 164

What is the prognosis after cataract surgery?

Answer 164

Most patients regain near-normal or normal vision post-surgery.

Enhanced ability to perform daily activities, reduced risk of falls, and better color perception.

Question 165

What is cellulitis?

Answer 165

Cellulitis is a bacterial infection of the skin and underlying tissues. The two main types affecting the eye are:

Periorbital Cellulitis: Involves only the eyelid and surrounding skin, not the orbit.
Orbital Cellulitis: A severe infection involving the muscles and fat within the orbit, potentially life-threatening.

Question 166

What are the two main types of cellulitis affecting the eye?

Answer 166

Periorbital Cellulitis: Involves only the eyelid and surrounding skin, not the orbit.

Orbital Cellulitis: A severe infection involving the muscles and fat within the orbit, potentially life-threatening.

Question 167

What are the common symptoms and physical exam findings for periorbital cellulitis?

Answer 167

Symptoms:

Unilateral eyelid swelling, redness, fever, warmth, and tenderness.

Physical Exam:

Clear conjunctiva.
Eye movements are free and vision is not impaired.
No limitation in extraocular movements.

Question 168

What are the common symptoms and physical exam findings for orbital cellulitis?

Answer 168

Symptoms:

Severe unilateral eyelid swelling, pain, fever, and the patient appears ill.

Physical Exam:

Ptosis (drooping of the upper eyelid).
Chemosis (swelling of the conjunctiva).
Conjunctivitis (red, inflamed eyes).
Limitation in eye movement and pain with eye movement.
Vision changes or loss of visual acuity.

Question 169

How can you differentiate between periorbital and orbital cellulitis based on physical examination?

Answer 169

Periorbital Cellulitis:

Localized to the eyelid with clear conjunctiva.

No restriction in eye movement or vision impairment.

Orbital Cellulitis:

Involves the orbit with symptoms like ptosis, chemosis, and conjunctivitis.

Limited extraocular movements, pain with eye movement, and vision changes.

Question 170

What should be included in the history and subjective assessment for cellulitis?

Answer 170

1) Onset and duration of symptoms.
2) Presence of pain, swelling, and fever.
3)History of trauma, recent sinus infection, or upper respiratory tract infection.
4) Any vision changes or double vision.
5) Recent dental procedures or infections.
6) Family history of similar conditions or autoimmune disorders.

Question 171

What are the diagnostic tests used for periorbital cellulitis?

Answer 171

CBC (Complete Blood Count): To check for leukocytosis, indicating infection.

Blood Cultures: To identify the causative organism and guide antibiotic therapy.

Question 172

What are the diagnostic tests used for orbital cellulitis?

Answer 172

CBC and Blood Cultures: To confirm infection and identify the causative agent.

CT Scan of the Orbit: To assess the presence and extent of abscesses, orbital involvement, and localize the infection. Essential for distinguishing between orbital and periorbital cellulitis.

Question 173

Why is orbital cellulitis considered a medical emergency?

Answer 173

Orbital cellulitis can lead to:

1)Abscess Formation: Risk of spreading to the brain, causing serious complications like meningitis.

2) Vision Loss: Increased pressure and inflammation within the orbit can damage the optic nerve.

3) Intracranial Spread: Potential for cavernous sinus thrombosis or other intracranial infections.

4) Sepsis: Systemic infection that can be life-threatening.

Question 174

What are the key differential diagnoses for cellulitis (orbital and periorbital)?

Answer 174

Thyroid-Associated Orbitopathy: Eye bulging and lid retraction, typically bilateral.

Orbital Myositis: Idiopathic inflammation of the eye muscles causing pain and eye movement limitation.

Orbital Pseudotumor: Inflammatory mass mimicking a tumor, causing pain, swelling, and vision changes.

Granulomatosis with Polyangiitis: Autoimmune inflammation of blood vessels affecting the orbit, presenting with proptosis and pain.

Carotid Cavernous Fistula: Abnormal connection between the carotid artery and cavernous sinus, presenting with pulsating exophthalmos and bruit.

Question 175

What is the epidemiology of orbital cellulitis?

Answer 175

More common in young children than in older children or adults.

Most cases arise as a complication of bacterial rhinosinusitis, with coexisting rhinosinusitis present in 86-98% of cases.

Ethmoid sinusitis and pansinusitis are the most likely forms of rhinosinusitis to lead to orbital cellulitis.

Question 176

What are the red flags in cellulitis that require immediate medical attention?

Answer 176

Limitation of eye movement or pain with eye movement.

Severe eye pain or vision changes.

Fever and systemic signs of illness.

Rapidly progressing swelling or redness around the eye.

Signs of proptosis (bulging of the eye) or decreased visual acuity.

Question 177

When should you refer a patient with cellulitis for immediate medical attention?

Answer 177

Periorbital Cellulitis: Refer if symptoms worsen or orbital involvement is suspected.

Orbital Cellulitis: Requires immediate hospitalization and IV antibiotics. Urgent referral to an ophthalmologist or an emergency department.

Question 178

What are the goals of therapy for cellulitis (orbital and periorbital)?

Answer 178

Eliminate Infection: Use of appropriate antibiotics to eradicate the infection.

Prevent Complications: Early identification and treatment to prevent abscess formation, vision loss, or intracranial spread.

Relieve Symptoms: Reduce pain, swelling, and other symptoms.

Restore Function: Preserve vision and normal eye movement.

Monitor for Recurrence: Ensure complete resolution of infection and educate the patient on signs of recurrence.

Question 179

What is conjunctivitis

Answer 179

inflammation of the conjunctiva, which is the membrane covering the white part of the eyes and the inner eyelids.

Question 180

What are the types of conjunctivitis?

Answer 180

classified into four main types:

Bacterial Conjunctivitis
Viral Conjunctivitis
Allergic Conjunctivitis
Chemical Conjunctivitis

Question 181

What are the common findings across all types of conjunctivitis?

Answer 181

Red eyes.

Eye drainage (type varies).

Itching (common in allergic conjunctivitis).

Question 182

What are the characteristic symptoms of bacterial conjunctivitis?

Answer 182

Fast onset within 12-24 hours.

Copious purulent or mucopurulent discharge.

Burning, stinging, or gritty sensation in the eyes.

Crusted eyelids upon awakening, with eyelid swelling.

Typically starts in one eye and may progress to both.

Beefy-red conjunctiva.

Question 183

What are the common causative organisms of bacterial conjunctivitis?

Answer 183

Haemophilus influenzae

Streptococcus pneumoniae

Staphylococcus aureus

Neisseria gonorrhoeae

Chlamydia trachomatis

Question 184

What are the characteristic symptoms of viral conjunctivitis?

Answer 184

tarts in one eye and may progress to both.

Watery discharge with tearing.

Sensation of a foreign body in the eye.

Systemic symptoms such as runny nose, sore throat, sneezing, and fever.

Preauricular or submandibular lymphadenopathy.

Photophobia and impaired vision.

Vesicular skin lesions and dendritic corneal ulcers in primary herpetic infection.

Question 185

What are the common causative viruses of viral conjunctivitis?

Answer 185

Adenovirus

Coxsackievirus

Herpes Simplex Virus (HSV)

Human Papillomavirus (HPV)

Enteric cytopathic human orphan (ECHO) viruses

Question 186

What are the characteristic symptoms of allergic conjunctivitis?

Answer 186

Itchy, watery eyes that are always bilateral.

Seasonal symptoms, often related to pollen exposure.

Eyelid edema without visual changes.

Hyperemia of eyes with possible giant papillae on the tarsal conjunctiva.

May present with eczema, urticaria, or asthma flare-ups.

Question 187

What are common causes of chemical conjunctivitis?

Answer 187

Iatrogenic: Caused by miotics, preservatives in eye drops, or contact lens solutions.

Occupational: Exposure to irritative chemicals.

Irritative: Exposure to household chemicals or pollutants.

Question 188

What should be included in the history-taking for conjunctivitis?

Answer 188

Onset, duration, and course of symptoms.

Presence and type of discharge (purulent, watery, etc.).

Changes in vision since symptoms began.

Any recent eye trauma or injury.

Past episodes of similar symptoms.

Contact with individuals having conjunctivitis.

Recent changes in contact lenses, solutions, or cosmetic products.

Personal and family history of allergies.

Question 189

What are the important steps in the physical exam for conjunctivitis?

Answer 189

Inspect:
**Observe eyes for redness, discharge, and foreign bodies.
**Check for lid edema and conjunctival color changes.

Palpate:
**Palpate preauricular, anterior, and posterior cervical lymph nodes for enlargement.

Check visual acuity:
**Use the Snellen chart to assess vision.

Auscultate:
**Heart and lungs to rule out systemic involvement.

Question 190

What diagnostic tests are recommended for conjunctivitis?

Answer 190

**Gram Stain: For discharge if gonococcal infection is suspected, especially in neonates.

**Culture for Chlamydia: If suspected based on history and symptoms.

**Fluorescein Stain: If foreign body, corneal abrasion, or ulceration is suspected.

**Visual Acuity Test: With Snellen chart, assess peripheral vision and extraocular movements (EOMs).

Question 191

What are the differential diagnoses for conjunctivitis?

Answer 191

Viral Conjunctivitis: Consider herpetic keratoconjunctivitis if vesicular lesions are present.

Bacterial Conjunctivitis: Consider gonorrheal or chlamydial infections if purulent discharge is present.

Corneal Abrasion: Sudden onset of pain and photophobia, usually with a history of trauma.

Blepharitis: Chronic inflammation of the eyelids with crusting and itching.

Drug-Related Conjunctivitis: Linked to recent use of eye drops or medications.

Iritis: Presents with photophobia, pain, and vision changes without significant discharge.

Question 192

What is the epidemiology of conjunctivitis?

Answer 192

Viral conjunctivitis is the most common type.

Conjunctivitis occurs in 1% to 12% of newborns.

Question 193

What are the red flags in conjunctivitis that require immediate referral?

Answer 193

Suspected periorbital cellulitis or herpes virus infection.

Significant vision change or eye pain.

Symptoms not responding to treatment.

Presence of a corneal ulcer or severe corneal involvement.

Question 194

What are the goals of therapy for conjunctivitis?

Answer 194

Relieve symptoms.

Prevent complications and preserve eyesight.

Prevent recurrence.

Cure or control infection where present.

Prevent transmission to others.

Question 195

What is the first-line treatment for viral conjunctivitis?

Answer 195

No antibiotics or antivirals indicated.

Use cold compresses, decongestants, and artificial tears to relieve symptoms.

Question 196

What are the first-line treatments for bacterial conjunctivitis?

Answer 196

Polymyxin B/Gramicidin Drops: OTC, for mild cases in adults, q3-4h for 2 days after symptoms resolve.

Erythromycin 0.5% Ointment: 1/2 - 1 inch QID (Rx).

Fusidic Acid 1% Drops: BID, for children > 2 years.

Trimethoprim-Polymyxin B Drops: 1-2 drops q3h.

Tobramycin 0.3% Drops or Ointment: 1-2 drops q4h, taper to BID-TID.

Question 197

What are the second-line treatments for more severe bacterial conjunctivitis?

Answer 197

Use broad-spectrum drops like Trimethoprim/Polymyxin B drops, Erythromycin ointment, or Fusidic acid drops for moderate to severe cases or treatment failure.

Question 198

What is the first-line treatment for HSV keratitis or keratoconjunctivitis?

Answer 198

1) Acyclovir 400 mg BID PO for up to 12 months (RxTx).

2) Trifluridine (Viroptic) 1% Solution: 1 drop Q2H while awake (max 9 drops/day) until re-epithelialization, then Q4H (max 5/day) for 7 days post re-epithelialization.