eyes Flashcards
(78 cards)
1
Q
antiglaucoma agents (6)
A
sympathomimetics, B-adrenergic blocking agents, carbonic anhydrase inhibtors, protaglandin analogs, cholinometics, mannitol
2
Q
when should you prescribe topical anesthetics?
A
you shouldn’t! not for home use, pt will not be able to feel changes or condition getting worse.
3
Q
what is a major contraindication for topical (eye drop) corticosteroids?
A
if you suspect an HSV infection
4
Q
4 side effects of corticosteroids?
A
ocular dryness, cataract, secondary infection, glaucoma
5
Q
5 vital characterizations to an ocular discomfort complaint
A
pain? FB? Photophobia? itching? scratching/burning?
6
Q
3 ways to describe ocular DC
A
purulent
watery
ropy/mucoid
7
Q
2 VITAL questions to ask when getting Hx on blindness/vision loss and changes
A
suddenly or over time?
painful??
8
Q
4 DX for diplopia
A
CN palsy
graves ophthalmopathy
trauma
degenerative dz
9
Q
normal eye sight
A
emmetropia
10
Q
nearsighted (far away is blurry)
A
myopia (MC refractive error)
11
Q
farsighted (close is blurry)
A
hyperopia
12
Q
gradual loss of near sight with age, d/t loss of elasticity
A
presbyopia
13
Q
one eye works better than the other
A
amblyopia
14
Q
misshapen eye that causes blurry vision; both near and far
A
astigmatism
15
Q
legal blindness
A
20/200 or less than 20 degrees of peripheral vision
16
Q
temporary loss of vision d/t decreased blood flow
A
amaurosis fugax
17
Q
1 worldwide cause of vision loss
A
cataracts
18
Q
1 cause of vision loss in the US? (2 causes, 2 populations)
A
diabetes (overall) macular degeneration (elderly)
19
Q
tonometry test
A
measures IOP, tests for glaucoma/eye dz that damages nerve
20
Q
3 painless causes of “red eye”
A
conjunctivitis (MC)
episcleritis (can also be painful)
subconjunctival hemorrhage
21
Q
10 painful causes of “red eye”
A
angle closure glaucoma corneal abrasion corneal ulcer episcleritis (+/- pain) scleritis iritis FB chemical conjunctivitis HSV/keratitis herpes zoster opthalmacus
22
Q
what is the most specific finding for viral conjunctivitis?
A
preauricular adenopathy
23
Q
MCC of viral conjunctivitis?
A
adenovirus
24
Q
common pathogens for baterial conjunctivitis
A
staph strep (esp strep pneumo) haemophilus pseudomonas moraxella chlamydia, gonococci
25
MC infectious cause of blindness worldwide
trachoma (chlamydia spread by flies)
26
pt presents with a erythematous, pruritic eye that has lacrimation on purulent DC. What is the treatment?
(bacterial conjunctivitis) ABX drops; Sulfa or Quinolone ($)
| luke warm compress
27
pt failed tx for bacterial conjunctivitis, you suspect chlamydial infection after getting a better hx; what's the tx?
```
azithromycin 1 g orally
or doxy (longer tx, less adherence)
```
28
a pt presents with a Hx of bilateral conjunctivitis for 1 week (tx is not working), what should you do???
refer to an allergist; it's allergic conjunctivitis (bilateral)
29
6 tx for allergic conjunctivitis
```
you can tx with:
mast cell stabilizers
topical antihistamines
systemic antihistamines (zyrtec, allegra, claritin)
topical corticosteroids
topical cyclosporin (for dryness)
avoid triggers
```
30
which fleshy overgrowth comes in from the nasal side usually? and what is it associated with?
pterygium
| -wind, sun, sand/dust exposure
31
tx for corneal abrasion (3 tx, 2 FU)
- topical ABX
- topical analgesics (NSAIDs)
- avoid contact use until healed
- follow up daily
- refer?
32
imaging of choice for corneal laceration
CT, look for penetration
| NO MRI
33
FB management includes wjhat type of follow up?
w/ ophthalmology in 24 hours!
34
pt presents with eye pain, photophobia, tearing, circumcorneal redness and impaired vision in the Left eye after sleeping with their contacts in for three days. upon examination you see an area of opacification on the scleral. What is the Tx? (4)
(confirm corneal ulceration, suspect bacterial)
* *Topical fluoroquinolones
- Topical cycloplegics
- Avoid eye patching
- Urgent referral to Ophthalmology (within 24 hours)
35
which ganglion does HSV live in, causing corneal ulcers
trigem
36
after fluorescein staining, you see an ulcer with *dendritic branching* what do you suspect?
HSV keratitis
37
HSV keratitis management (5)
- op referral!
- topical antivirals
- for stromal (deep) involvement, systemic antivirals
- long term oral prophylaxis (valacyclovir/acyclovir)
- NO TOPICAL STEROIDS OR ANESTHETICS
38
63 yo male pt presents to your urgent care with a complaint of feeling super tired for a week and all of a sudden a painful, burning, itchy lesion popped up on the tip of his nose. What do you do?!?!?
(he's got the Zoster- and it's gonna involve his eye!)
- initiate high dose systemic antiviral ( W/ IN 72 HOURS!!!)
- topical ABx for secondary infections
- URGENT op referral (same day)
39
what is a common cause of keratitis in contact wearers?
acanthamoeba keratitis
| (amoeba) yuck yuck yuck
40
pt presents with severe pain, redness, scant DC and ring infiltrates seen with super duper magnification. PT wears contacts and takes poor care of the- they also make their own organic solution. How do you treat them?
(acanthamoeba keratitis )
- topical biguanides (PHMB/ antiseptic)
- corneal scraping
- corneal grafting
- topical corticosteroids (?)
41
PT presents with severe bilateral eye pain that seemed to appear out of no where. He worked the night shift last night but didn't report pain until this afternoon. He is also experiencing photophobia. Fluorescein staining reveals punctate on both corneas. PT is a welder and often forgets his eye protection. What is the tx? (5)
(UV/ Actinic Keratitis)
- topical cycloplegics
- topical NSAIDs in office
- rest/patching/dark room
- EDUCATE (eye protection)
- reassurance, it will go away in 24-48 hrs (it's like a sun burn for your eyes)
42
Your SLE patient comes to you with a new complaint of mild eye pain, you notice the eye has ocular injection and has engorged episcleral vessels. Their visual acuity is normal. How do you treat this? (3)
(epicleritis)
- topical NSAIDs
- if recurrent, refer! (may need topical steroids)
- educate: if recurrent or boaring pain, could deteriorate to scleritis (esp for pt's with collagen vascular dz)
43
what differentiates scleritis from episclertis?
scleritis is deeper; inflammation of whole eye; deep pain, photophobia, bluish hue to scelera. may have visual loss (epi=no visual loss)
-scleritis is urgent referral!!
44
what parts of the eye does uveitis involve?
iris or ciliary body (anterior), choroid (posterior)
45
patient presents with mild vision loss and vision loss. Upon examination it looks like there is beads of condensation in the anterior chamber. The iris also looks as though it is an irregular shape (what the heck is up with that?) and how do you treat it? (4 tx/management + explanation of findings)
"condensation" =mutton fat precipitates!
Irregular iris shape= synechiae d/t adhesions pulling iris out of shape
(uveitis)
-refer to op
-topical steroids
-cycloplegics (prevent synechia)
-work up for narly inflamatory condition (UC, Crohn's, psoriasis) or infection (toxoplasmosis, TB, syphilis, HIV associated infections
46
Which chemical injury tends to penetrate deeper?
alkaline
47
Pt presents after being splashed in the eyes with some unknown chemical in a research lab. What is your plan of action?
- get someone to call op while you:
- test pH (after 1st L or 2 of irr.)
- IRRIGATE A SHIT TON (up to 8-10 L normal saline)
- slit lamp after irrigation, check for injury
- evert lids, FB/injury check
- measure IOP
- topical cycloplegics, ABX, systemic pain meds
48
diseases of adnexa includes.... (7)
```
blepharitis
en/ectropion
chalazion
hordeolum
dacryocystitis
periorbital cellulitis
orbital cellulitis
```
49
what's the big issue with ectropion?
reduced protection/ moistening ability
50
S/Sx of anterior blepharitis (6)
- inflammation of the lids
- flaking/scaling of lids
- irritation, burning, itching
- red-rimmed lid margins w/ scaling and clinging scales
51
S/Sx of posterior blepharitis (9)
-meibomian gland inflammation
-hyperemic, "beefy" lid margins
+/- telangectasias
+/- mild entropion
+/- greasy tears
anterior blepharitis
irritation, burning, itching
52
what other condition has a strong association with posterior blepharitis?
acne rosacea
53
how do you tx anterior blepharitis?
- warm compress TID-QID
- cleanse with Qtip and baby shampoo
- topial Abx (?)
54
tx for posterior blepharitis (6)
-consider referral
-local care, same as anterior
-Systemic ABx
+/-short course of topical Abx
+/- short course of topical steroids
-antivirals for HSV
55
looks like your patient has a narly infection of their lacrimal duct, what's the big girl term for this?
dacryocystitis
56
pt presents with a huge oozy cyst on their medial canthis. Pureulent DC culture comes back as staph aureus. Whats going on and how do you treat it?
acute dacryocysitis
- anti staph ABX
- if it's really narley, surgical decompression
57
How do you differentiate b/t orbital cellulitis and periorbital cellulitis?
orbital has restricted or painful EOM and proptois, they are SICK (constitutional signs)
58
What's the little BB or pea in the eyelid
chalazion
59
Causes of keratoconjunctivitis sicca
age, sjogrens, systemic drugs (anticholinergics)
60
DDX for ptosis (4)
- horner's syndrome
- 3rd CN palsy (levator palpibre)
- meysthenia gravis (fatigue w/ chewing)
- age
61
3 DDX for exopthamos
graves
orbital cellulitis
retrobulbar tumor (unilateral)
62
what is Hertel Exopthalmomoetry used for?
measures eyes protruding
| *do on Graves pts
63
Painless causes of Acute vision loss (9)
```
Amaurosis fugax
CRAO
CRVO
BRAO
ischemic optic neuropathy
retinal detachment
vitreous hemorrhage
papilledema
cortical blindness/CVA
```
64
painful causes of acute vision loss
angle closure glaucoma
hyphema
optic neuritis
65
what is hyphema and the stages?
- blood in the anterior chamber
| - microhyphema (dots of blood), I (
66
exam findings for angle closure glaucoma
- mid dilated/fixed pupil
- steamy cornea
- pupil nonreactive to light
- inceased IOP (usually over >50mmHg)
67
4 tx for emergent management of acute angle closure glaucoma
- aecazolamide
- mannitol (if pressure is not decreasing)
- topical: pilocarpine (ciliary contraction of pupil)
- iridotomy
68
2 important things about the presentation of optic neuritis
pain w/ EOM
| color vision is often affected
69
what do you see in central retinal artery occlusion?
ocular emergency!!
- sudden, profound vision loss w/ afferent pupil defect
- boxcar segmentation of retinal veins
- retinal pallor
- cherry red spot on macula
70
management of Central retinal artery oclusion
- increase O2 supply/blood flow (supine/O2)
| - reverse obstruction (thrombolytics? massage?)
71
how does branch retinal artery occlusion present?
-visual field loss
72
how does central retinal vein occlusion present
- blood and thunder fundus
| - semi-acute unilateral vision loss
73
how does ischemic optic neuropathy present? (5 +2 demographics)
- sudden decreased visual acuity
- painless!
- segmental field cuts
- pale/swollen optic disc
- quadrantic or full vision loss
- type 2 diabetes/vascular compromise
74
3 findings of retinal detachment
- afferent pupillary defect
- decreased visual acuity
- you see a "mountain" in the fundoscopic exam (retina folding on itself)
75
6 causes of chronic vision loss
- chronic open angle glaucoma
- cataract
- diabetic retinopathy
- HTNsive retinopathy
- macular degeneration
- retinitis pigmentosa
76
What are the diagnostic requirements for chronic open angle glaucoma?
REPRODUCIBLE PRESENCE OF 2/3:
1. increased IOP
2. disk cupping
3. visual field disturbances
77
age related macular degeneration findings:
neovascular (wet) : soft drusen, sudden vision loss from retinal detachment
atrophic (dry): mild/moderate vision loss, drusen
78
what do you associate with CMV retinitis? (hint its BADDDDD)
karposi's sarcoma (and also cheese pizza retina)
