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Clin Med I > Eyes > Flashcards

Eyes Flashcards

1
Q

general things to check for during an eye exam

A
  • physical exam
  • visual acuity
  • visual field
  • color vision
  • eye movements
  • pupils
  • IOP
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2
Q

components of anterior segments

A
  • lids
  • conjunctiva
  • cornea
  • iris
  • lens
  • anterior chamber
  • anterior vitreous
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3
Q

how do you best view the anterior segment

A

slit lamp

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4
Q

how do you best view the posterior segment

A

fundoscopy

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5
Q

components of the posterior segment

A
  • retina

- optic disc

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6
Q

what is the best imaging for the eye

A

CT

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7
Q

what bones of the orbit are most likely to break?

A
  • maxilla
  • zygoma
  • frontal
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8
Q

medial canthal ligament

A
  • attaches corner of the tarsal plate to the orbital wall
  • found inside eyelid
  • disruption -> malposition of eyelids
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9
Q

lateral canthal ligament

A
  • attaches to lateral aspect of orbit
  • found inside eyelid
  • disruption -> malposition of eyelids
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10
Q

who is most likely to get orbital fx?

A
  • children and adolescents d/t sports trauma

- adults d/t assaults or MVA

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11
Q

clinical presentation of orbital fx

A
  • deformity
  • pain
  • hematoma
  • subconjunctival hemorrhage
  • pain with eye mvmt
  • diplopia
  • facial numbness
  • N/V
  • bradycardia
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12
Q

physical deformities possible d/t orbital fx

A
  • proptosis d/t hematoma
  • enopthalmus d/t herniation of globe contents into sinus
  • extrusion of intraoccular contents
  • subcutaneous emphysema
  • widened intracanthal distance
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13
Q

orbit fx types

A
  • orbital zygomatic fx
  • nasoethmoid fx
  • orbital roof fx
  • orbital floor fx
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14
Q

orbital zygomatic fx

A
  • most common fx of orbital rim
  • d/t high impact blow to lateral orbit
  • usually associated with orbital floor fx
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15
Q

nasoethmoid fx

A
  • medial orbital rim
  • disruption of medial canthal ligament and lacrimal duct system
  • medial rectus muscle entrapment
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16
Q

orbital roof fx

A
  • more common in kids
  • expose larger portion of upper surface
  • high association with intracranial injury
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17
Q

orbital floor fx

A
  • aka blowout fx
  • d/t small round object hitting eye
  • displacement of globe backwards
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18
Q

concerns associated with orbital floor fx

A
  • entrapment of inferior rectus m
  • orbital fat
  • resulting ischemia and loss of muscle fn
  • fx fragment or compression by hematoma
  • herniation of tissue into maxillary sinus
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19
Q

hyphema

A
  • blood in anterior chamber
  • usually assoc with corneal abrasions
  • may be visible on gross inspection
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20
Q

what is the most common source of blood in hyphemas?

A
  • tear in anterior face of ciliary body

- direct blow can also rupture vessels at root of iris

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21
Q

common causes of hyphema

A
  • blunt trauma or penetrating injury
  • finger
  • hockey stick
  • deployed airbag
  • paintball
  • assault
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22
Q

clinical presentation of hyphema

A
  • vision loss
  • eye pain with pupillary constriction
  • photophobia
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23
Q

management of hyphema

A
  • slit lamp to exclude open globe injury like laceration
  • tetracaine
  • pain control, N/V control
  • keep head at 30 degrees to promote settling of blood
  • patch
  • ophthalmic consult
  • monitor IOP
  • topical steroids
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24
Q

who has a poorer prognosis for hyphema?

A
  • anyone with bleeding disorders or sickle cell
  • need to order lab work
  • also depends on grading
  • grade 4= 100% anterior chamber filling
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25
Q

corneal abrasion

A
  • result of eye trauma, retained foreign body, or improper contact use
  • defect in corneal surface epithelium
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26
Q

what innervates the cornea

A

trigeminal nerve

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27
Q

how many layers does the cornea have

A

six

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28
Q

what is the most frequent cause for ophthalmic emergencies?

A
  • foreign body with corneal abrasion
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29
Q

clinical presentation of corneal abrasion

A
  • eye pain
  • tearing
  • redness
  • photophobia
  • blurred vision
  • foreign body sensation
  • can sometimes see epithelial defect on gross exam
  • normal or decreased visual acuity
  • corneal edema
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30
Q

diagnosis of corneal abrasion

A
  • gross exam
  • fundoscopy
  • slit- lamp exam
  • flourescein after globe ruled out
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31
Q

management for corneal abrasions

A
  • topical erythromycin, polymyxin, or sulfacetamide
  • no patching
  • dont need f/u for small abrasions
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32
Q

management for corneal abrasions in contact wearers

A
  • antipseudomonals
  • ciproflox drops
  • oxiflox drops
  • gentamicin or tobramicin
  • ophthalmology f/u
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33
Q

indications for ophthalmologist f/u with corneal abrasions

A
  • large abrasions
  • contact lens wearers
  • young children
  • vision changes
  • rust ring
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34
Q

corneal ulcers

A
  • serious
  • involves multiple layers of cornea
  • major cause of impaired vision and blindness
  • extends through stroma
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35
Q

causes of corneal ulcers

A
  • exposure keratitis
  • allergies
  • severe dry eye
  • autoimmune disease
  • vit A deficiency
  • trauma
  • direct microbial invasion
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36
Q

common bacteria that cause corneal ulcers

A
  • pseudomonas
  • staph
  • strep
  • MRSA
  • moraxella liquefaciens
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37
Q

common virus that cause corneal ulcers

A

HSV/ zoster

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38
Q

corneal ulcers risk factors

A
  • contact lens wearer
  • previous eye surgery
  • eye injury
  • hx of herpes
  • use of topical or systemic . steroids
  • immunocompromised
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39
Q

clinical presentation of corneal uclers

A
  • red eye*
  • ocular pain*
  • discharge
  • swelling of eyelids
  • photophobia
  • foreign body sensation
  • blurred vision
  • eyelids and conjunctiva erythematous
  • mucopurulent discharge
  • round or irregular ucler with white hazy base
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40
Q

corneal ulcer exam

A
  • slit lamp

- r/o herpes zoster

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41
Q

corneal ulcer diagnosis

A
  • made clinically
  • scrape ulcer and culture to determine pathogen
  • done by ophthalmologist
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42
Q

corneal ulcer treatment

A
  • aggressive topical treatment
  • abx- fluoroquinolones
  • topical antifungals- fluconazole, amphoteracin
  • antivirals- ganciclovir, acyclovir
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43
Q

when should you refer someone to ophthalmologist for corneal ulcers

A
  • within 12-24 hours
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44
Q

complications of corneal ulcers

A
  • corneal scarring
  • corneal perforation
  • glaucoma
  • cataracts
  • blindness
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45
Q

what is the worst chemical injury to the eye

A
  • alkali burns
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46
Q

acid burns

A
  • dissociate into H ions in cornea
  • damage ocular surface by changing pH
  • produce protein coagulation which prevents deeper penetration of acids into eye
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47
Q

common acids that injure eye

A
  • battery acid
  • bleach
  • glass polish
  • vinegar
  • hydrochloric acid
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48
Q

alkali burns

A
  • dissociate into hydroxyl ion
  • liquifies fatty acid of cell membrane
  • can penetrate cell membrane
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49
Q

common alkali that injure eye

A
  • ammonia
  • lye
  • lime
  • airbag rupture
  • fireworks
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50
Q

chemical injury managment

A
  • litmus paper
  • copious irrigation with saline
  • morgan lens use until pH is neutral
  • emergent consult and f/u with ophthalmology
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51
Q

corneal foreign body clinical presentation

A
  • pain
  • foreign body sensation
  • photophobia
  • tearing
  • red eye
  • blurred vision
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52
Q

diagnosis of foreign body

A
  • clinical exam
  • evert eyelid
  • fluorescein
  • slit lamp
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53
Q

exam findings for foreign bodys

A
  • normal or decreased visual acuity
  • conjunctival injection
  • ciliary injection
  • visible foreign body
  • rust ring
  • epithelial surface defects with fluorescein
  • excessive tearing
  • corneal edema
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54
Q

foreign body management

A
  • remove foreign body
  • topical abx if no open globe injury
  • irrigation
  • can use q-tip, sterile needle tip
  • no contacts
  • ophthalmology referral
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55
Q

topical drops for foreign body management

A
  • erythromycin
  • cipro
  • cycloplegic
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56
Q

open globe injury

A
  • may accompany multiple trauma or serious head injury
  • tetanus prone wound
  • can be occult on gross exam
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57
Q

clinical presentation of open globe injury

A
  • obvious corneal or scleral laceration
  • volume loss
  • protruding foreign body
  • extruding intraocular contents
  • decreased visual acuity
  • relative afferent pupillary defect
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58
Q

diagnosis of open globe injury

A
  • CT
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59
Q

management of open globe injury

A
  • NPO- may need sx
  • dont remove FB
  • patch both eyes
  • place head at 30 degrees
  • treat nausea and pain aggressively
  • provide sedation
  • IV abx
  • ophthalmic consult
  • surgical repair within 24 hours
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60
Q

subconjunctival hemorrhage cause

A
  • fragile conjunctival vessel rupture
  • trauma
  • increased venous pressure
  • spontaneous
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61
Q

treatment for subconjunctival hemorrhage

A
  • reassurance
  • will resolve in 2-3 weeks
  • multiple episodes warrant further work up
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62
Q

topical cyclopelgics

A
  • paralyze ciliary muscles
  • cyclopentolate
  • homatropine
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63
Q

conjuctivitis

A
  • red eye d/t inflammation of conjunctiva

- usually self limited

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64
Q

conjunctivitis and contact lens wearers

A
  • high risk of pseudomonal keratitis

- higher risk for extended wear pts

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65
Q

red flags associated with conjunctivitis

A
  • reduction of visual acuity
  • ciliary flush
  • photophobia
  • severe foreign body sensation
  • corneal opacity
  • fixed pupil
  • severe HA with nausea
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66
Q

bacterial conjunctivitis

A
  • more common in kids
  • spread- direct contact
  • usually unilateral
  • yellow/ green/ white d/c
  • eye sticks shut, crusting
  • sand/gritty feeling
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67
Q

common causes of bacterial conjunctivitis

A
  • s. aureus
  • s. pneumoniae
  • h. flu
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68
Q

what should you do in any eye complaint

A
  • fluorescein

- fundoscopy

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69
Q

management of bacterial conjunctivitis

A
  • erythromycin ophthalmic ointment
  • trimethoprim- polymyxin drops
  • fluoroquinolone drops for contact wearers
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70
Q

viral conjunctivitis

A
  • usually have viral prodrome of sore throat, fever, LAD, pharyngitis
  • spread by direct contact
  • watery d/c with burning
  • gritty feeling
  • usually affects both eyes
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71
Q

common cause of viral conjunctivitis

A
  • adenovirus

- have rapid test for adenovirus now

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72
Q

management of viral conjunctivitis

A
  • self limited
  • gets worse in first 3-5 days
  • can use topical antihistamines and compresses
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73
Q

allergic conjunctivitis

A
  • airborne allergens come in contact with eye
  • very itchy eyes- possible corneal abrasions
  • bilateral
  • marked chemosis (swelling)
  • allergic shiners
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74
Q

management for allergic conjunctivitis

A
  • remove offending agent
  • wear sunglasses
  • change filters, clothes
  • antihistiamine/ vasoconstrictor combo (naphcon-A)
  • steroids (can raise IOP)
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75
Q

traumatic conjunctivitis

A
  • d/t foreign body

- treatment is removal of fb

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76
Q

toxic conjunctivitis

A
  • due to chemical burns
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77
Q

diagnosis of conjunctivitis

A
  • clinical dx
  • based on hx and exam
  • fluoroscein and fundoscopy exam
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78
Q

preseptal/ periorbital cellulitis

A
  • infection of anterior eyelid
  • no orbit involvement
  • mild with rare complications
  • usually d/t external sources
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79
Q

causes of periorbital cellulitis

A
  • insect/ animal bites
  • foreign body
  • dacryocystitis
  • conjunctivitis
  • hordeolum
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80
Q

common bacterial causes of periorbital cellulitis

A
  • s. aureus
  • s. pneumoniae
  • MRSA
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81
Q

clinical manifestations of periorbital cellulitis

A
  • ocular pain
  • eyelid swelling
  • erythema
  • warmth
82
Q

diagnosis of periorbital cellulitis

A
  • history and PE

- Ct or MRI

83
Q

management of periorbital cellulitis

A
  • doxycycline
  • clindamycin PO
  • keflex PO
  • for MRSA can give bactrim plus amoxicillin or ceph
84
Q

orbital cellulitis

A
  • infection of contents of orbit

- no globe invovement

85
Q

causes of orbital cellulitis

A
  • rhinosinusitis**
  • orbital trauma
  • dacryocystitis
  • tooth infection
  • opthalmic surgery
86
Q

most common bacterial causes of orbital cellulitis

A
  • s. aureus

- strep

87
Q

clinical manifestations of orbital cellulitis

A
  • swelling
  • erythema
  • warmth
  • ophthalmoplegia
  • proptosis
  • pain with eye movement
  • diplopia
88
Q

complications of orbital cellulitis

A
  • orbital abscess
  • subperiosteal abscess
  • brain abscess
  • cavernous sinus thrombophlebitis
89
Q

dx of orbital cellulitis

A
  • clinical

- confirmed with CT or MRI

90
Q

management of orbital cellulitis

A
  • vanco plus ceph
  • unisyn/ zosyn plus ceph
  • should see improvement in 24-48
    hours
  • may require surgery
91
Q

herpes keratitis

A
  • corneal infection and inflammation
  • major cause of blindness
  • spread- direct contact
  • mostly unilateral involvement
92
Q

what is the most common type of herpes keratitis

A
  • infectious epithelial keratitis

- endemic in humans

93
Q

clinical manifestations of herpes keratitis

A
  • pain
  • visual burning
  • tearing
94
Q

diagnosis of herpes keratitis

A
  • conjunctival injection

- dendritic lesions on fluorescein

95
Q

management of herpes keratitis

A
  • topical antivirals for mild cases

- PO plus topical antivirals for more severe cases

96
Q

what are the meibomian glands?

A
  • found on inside rim of eyelids
  • sebaceous glands that secrete oily substance to keep eyes lubricated
  • dysfunction -> dry eye
97
Q

blepharitis

A
  • chronic inflammation of eyelids
  • intermittent exacerbations
  • anterior less common
  • posterior more common
98
Q

anterior blepharitis

A
  • inflammation at base of eyelids
  • more common in young females
  • 2 types- staph or seborrheic dermatitis
99
Q

clinical manifestations of anterior blepharitis

A
  • eyelid edges are pink, irritated, swollen with crust
  • malposition of eyelids with chronic
  • eyelashes misdirected or thinning
  • diffuse conjunctival injection
100
Q

posterior belpharitis

A
  • associated with other skin conditions like rosacea and seborrheic dermatitis
  • gland gets plugged and inflamed -> dry eye
101
Q

clinical manifestations of posterior blepharitis

A
  • red, swollen eye
  • gritty sensation
  • burning, excessive tearing
  • itchy eyelids
  • crusting
  • flaking eyelid skin
  • photophobia
  • blurred vision
102
Q

diagnosis of blepharitis

A
  • clinical, history and PE

- distinguish anterior from posterior

103
Q

management of blepharitis

A
  • counseling
  • alleviate acute sx
  • warm compresses
  • lid massage and washes
  • artificial tears
  • topical abx for anterior, PO abx if severe
104
Q

hordeolum

A
  • aka stye
  • acute, purulent inflammation of eyelid
  • can be sterile or show bacteria (staph)
105
Q

internal hordeolum

A
  • infection of meibomian gland

- conjunctival side

106
Q

external hordeolum

A
  • infection of eyelash follicle

- lid margin

107
Q

management of hordeolum

A
  • warm compress
  • +/- topical abx
  • may harden to chalazion
108
Q

chalazion

A
  • chronic inflammatory lesion
  • d/t blockage and swelling of meibomian gland of eyelid
  • usually in pts with eyelid margin blepharitis and rosacea
109
Q

progression of chalazion

A
  • may start as small, red, tender, swollen
  • 2-3 days becomes painless and larger, rubbery, nodular
  • inflammation and blockage, not infection
110
Q

treatment of chalazion

A
  • self limited to few weeks- months
  • warm compresses
  • eyelid massage
  • if non-resolving refer to optho for I&D
111
Q

ectropion

A
  • lower eyelid rolled out
  • sagging eyelid -> dry eye, irritation
  • usually d/t aging, can be d/t facial nerve paralysis
112
Q

clinical manifestations of ectropion

A
  • excessive tearing
  • chronic inflammation
  • redness
  • gritty
  • dry eye
  • crusting
  • multiple infections
  • eyelids dont close properly
113
Q

management of ectropion

A
  • artificial tears as temp fix

- requires surgery

114
Q

entropion

A
  • eyelid rolls inward
  • eyelashes rub against conjunctiva
  • causes chronic irritation
  • d/t aging, trauma, scarring, surgery
115
Q

clinical manifestations of entropion

A
  • red eye
  • irritated
  • gritty
  • tearing
  • mucous discharge
  • photophobia
  • corneal abrasions
  • absent eyelashes
116
Q

management of entropion

A
  • artificial tears as temp fix

- surgery

117
Q

dacryoadenitis

A
  • inflammation of lacrimal glands
  • usually d/t bacteria or virus
  • most common in kids and neonates
118
Q

what is the most common viral cause of dacryoadenitis

A
  • mumps
119
Q

clinical manifestations of dacryoadenitis

A
  • unilateral
  • severe pain
  • redness
  • swelling
  • supraorbital pressure
  • rapid onset
  • conjunctival swelling
  • submandibular LAD
  • exopthalmos
  • ocular motility restrictions
  • can have systemic sx
120
Q

chronic manifestations of dacryoadenitis

A
  • usually bilateral
  • painless enlargement
  • present more than a month
  • more common than acute
121
Q

dx of dacryoadenitis

A
  • lacrimal gland enlarged
  • easily seen with eversion of upper lid
  • CT
122
Q

management of dacryoadenitis

A
  • most common cause= mumps, self limiting
  • bacterial- keflex
  • inflammatory cause- look for systemic causes like autoimmune diseases
123
Q

dacryostenosis

A
  • nasolacrimal duct obstruction
  • most common cause of persistent tearing in infants
  • spontaneous resolutino in 6-12 mo
124
Q

treatment of dacryostenosis

A
  • massage

- lacrimal duct probing

125
Q

retinal detachment

A
  • seperation of retina from pigment epithelium and choroid
  • traction or tears -> fluid accumulation -> detachment
  • can result in permanent blindness
  • most uncomplicated spontaneous detachments can be cured
126
Q

risk factors for retinal detachment

A
  • myopia
  • previous ocular surgery
  • fluorquinolone use
  • trauma
  • family hx
  • marfan disease
127
Q

causes of retinal detachment

A
  • tears or holes either traumatic or spontaneous
  • traction of retina- usually diabetic retinopathy
  • tumors
  • exudative process
128
Q

clinical manifestation of retinal detachment

A
  • increasing number of floaters
  • flashes of lights
  • shower of black spots
  • curtain spreading over visual field
  • progression varies
  • on exam see “billowing sail” or “ripple on pond” appearance
129
Q

differentail dx for retinal detachment

A
  • vitreous hemorrhage
  • vitreous inflammation
  • ocular lymphoma
  • intra-ocular FB
130
Q
  • treatment for retinal detachment
A
  • ophthalmologist consult immediately
  • drain subretinal fluid
  • laser photocoagulation
  • cryotherapy
  • pneumoretinopexy
  • scleral buckle placement
  • vitrectomy
  • goal= close tears
131
Q

optic neuritis

A
  • inflammation of optic nerve
  • normal fundus exam
  • closely associated with MS
132
Q

causes of optic neuritis

A
  • MS***
  • sarcoidosis
  • neuromyelitis optica
  • herpes zoster
  • SLE
133
Q

clinical manifestations of optic neuritis

A
  • unilateral vision loss*
  • pain exacerbated by movement*
  • central vision loss
  • pain behind eye
  • usually improves in 2-3 weeks
134
Q

differential dx for optic neuritis

A
  • infections of optic n
  • retinal detachent
  • giant cell arteritis
135
Q

treatment of optic neuritis

A
  • brain MRI- MS dx
  • consult neurologist
  • systemic steroid use controversial
  • treat MS plaques with interferon beta-1a
136
Q

papilledema

A
  • PE finding
  • loss of definition of optic disc d/t edema
  • central vessels get pushed forward and veins dilated
  • cause= increased ICP
  • may be confused with HTN retinopathy
137
Q

causes of papilledema

A
  • mass lesions
  • cerebral edema
  • hydrocephalus
  • obstruction of venous outflow
  • idiopathic intracranial HTN
138
Q

clinical manifestations of papilledema

A
  • HA that is worse in AM or when lying down**
  • N/V
  • diplopia
  • transient visual blurring
139
Q

stages of papilledema

A
  • early
  • fully dev
  • late chronic
140
Q

early papilledema

A
  • loss of venous pulsations

- optic cup retained

141
Q

fully dev papilledema

A
  • disc margins obscured
  • cup obliterated
  • blood vessels blurred
  • flamed hemorrhage
  • cotton wool spots
142
Q

late chronic papilledema

A
  • cup obliterated
  • hemorrhage and exudative components resolved
  • nerve is flat
  • disc pallor
143
Q

diagnosis of papilledema

A
  • MRI or CT
  • LP to check for opening pressure
  • visual field test
144
Q

treatment for papilledema

A
  • reduce and monitor ICP
  • diuresis
  • hypertonic saline
  • steroids
  • hyperventilation- ICU
  • barbituates
  • remove CSF- shunting
  • decompressive craniectomy- emergency only
145
Q

idiopathic intracranial HTN

A
  • bilateral papilledema
  • N/V
  • HA
  • blurred vision/ visual field defects
  • CN VI paresis
  • most common in obese women of childbearing age
146
Q

management of idiopathic intracranial HTN

A
  • usually self limited
  • weight loss
  • serial LPs
  • high dose steroids
  • surgery for severe cases
147
Q

retinal a occlusion

A
  • usually d/t embolism
  • sudden painless loss of vision
  • form of stroke
  • vision loss depends on a affected
148
Q

central retinal a occlusion

A
  • sudden loss of vision in one eye
  • transient monocular blindness, stuttering, or fluctuating course
  • painless
149
Q

branch retinal a occlusion

A
  • monocular vision loss

- restricted to just one part of visual field

150
Q

what is the most common cause of retinal a occlusion

A
  • carotid artery atheroscleorsis
151
Q

associated sx of retinal a occlusion

A
  • HA if from GSA or carotid dissection
  • unilateral numbness, weakness, slurred speech
  • marcus gunn pupil
  • cherry red spots on macula
  • check inflammatory markers on labs
152
Q

retinal vein occlusion

A
  • d/t chronic diseases that slow venous BF
  • results in neovascularization which are fragile and prone to hemorrhage
  • either branch, central, or hemiretinal v occlusion
  • sudden painless vision loss
153
Q

conditions associated with retinal v occlusion

A
  • DM
  • HTN
  • leukemia
  • sickle cell disease
  • multiple myeloma
154
Q

esotropia

A
  • eye points in
155
Q

exotropia

A
  • eye points out
156
Q

hypertropia

A
  • eye points up
  • not common
  • usually d/t CN IV palsy from trauma
  • pt presents with head turn and head tilt to minimize diplopia
157
Q

hypotropia

A
  • eye points down
158
Q

causes of strabismus

A
  • congeital
  • refractive error -> esotropia
  • convergence error -> exotropia
  • certain medical conditions are at higher risk
159
Q

medical conditions at higher risk of strabismus

A
  • down’s syndrome
  • cerebral palsy
  • stroke
  • head injuries
  • prematurity and low birth weight
160
Q

causes of strabismus in children

A
  • RB
  • thyroid eye disease
  • oblique palsy
  • brown syndrome
  • duane syndrome
  • down syndrome
  • head trauma
  • cerebral palsy
161
Q

treatment for strabismus

A
  • lenses
  • prism
  • vision therapy
  • surgery
  • botox
162
Q

ambliopia

A
  • aka lazy eye
  • happens when there is a disruption between retina and brain as a child
  • suppression of vision in one eye d/t strabismus -> nerves dont develop
163
Q

new onset strabismus/diplopia in adults

A
  • aneurysm until proven otherwise (often CN 3 palsy and aneurism in middle cerebral a or posterior communication a)
  • gradual onset- tumor
  • transient or persisting- temporal arteritis
  • variable diplopia
164
Q

pterygium

A
  • triangular thickening of bulbar conjunctiva growing toward cornea
  • usually d/t excessive sun exposure
  • aka surfers eye
  • 2X more common in males
165
Q

pathophys of pterygium

A
  • benign fibro-vascular proliferation and basophilic degeneration of corneal collagen
  • matrix metalloproteases break down proteins
  • destroys bowmans layer -> scarring and vision loss
166
Q

differential dx for pterygium

A
  • pannus- contact lens overuse

- phlyctenular keratitis- TB or staph sensitivity

167
Q

treatment for pterygium

A
  • prevention*- sunglasses or hats
  • topical lubricants and steroids
  • surgery
168
Q

complications of pterygium

A
  • irritated gritty eyes
  • cosmetic appearance
  • contact lens intolerance
  • astigmatism
  • decreased vision
169
Q

cataracts

A
  • denatured protein in eye, usually d/t UV light
  • can be congenital, age related, traumatic, or secondary (DM, steroids)
  • creates a lot of glare
170
Q

nuclear cataracts

A
  • earliest cataracts
  • minimal impact on vision
  • often assoc with fetal alcohol syndrome or congenital issues
  • can dev from rubella or syphillis
171
Q

cortical cataracts

A
  • added layers to lens throughout life
  • starts at edge of lens and grows in like spokes to center
  • impacts visual acuity
172
Q

posterior capsular cataracts

A
  • looks like smudge or dirt on lens

- most visually devistating

173
Q

treatment for cataracts

A
  • new glasses or prescription
  • sunglasses for glare
  • surgery (around 20/40 vision mark)
174
Q

complications of cataracts

A
  • hyper-mature cataract
  • decreased vision
  • riskier surgery
175
Q

glaucoma

A
  • increased IOP
  • puts pressure on optic N and can result in vision loss (increased cup to disc ratio)
  • impacts portions of visual field
176
Q

what is the most common type of glaucoma

A
  • open angle
177
Q

types of glaucoma

A
  • primary open angle
  • congenital
  • secondary
  • angle closure glaucoma
  • low tension glaucoma
  • pigmentary glaucoma
178
Q

low tension glaucoma

A
  • pressure is not high but is high enough to damage already unhealthy optic n
179
Q

criteria for legally blind

A
  • 20/200 visual acuity OR

- 10 degrees of visual field

180
Q

treatment for glaucoma

A
  • topical meds***

- surgery

181
Q

what are the topical meds commonly used for glaucoma?

A
  • prostaglandins*
  • beta blockers*
  • alpha adrenergic agonists
  • carbonic anyhdrase inhibitors
  • miotics
182
Q

prostaglandins

A
  • glaucoma topical drops
  • increase uveoscleral outflow
  • ADRs- lash and hair growth, atrophy of orbital fat, worsens ocular inflammation
183
Q

beta blockers

A
  • glaucoma topical drops

- decrease aqueous humor production

184
Q

alpha adrenergic agonists

A
  • glaucoma topical drops

- decrease aqueous production and increase outflow

185
Q

carbonic anhydrase inhibitors

A
  • glaucoma topical drops

- decrease aqueous production

186
Q

miotics

A
  • glaucoma topical drops

- increase outflow through trabecular meshwork

187
Q

angle closer glaucoma

A
  • usually unilateral
  • occurs in pts with anatomically narrow angles- iris sits closer to cornea
  • can occur in pts with cataracts
  • very red eyes
  • very nauseas
  • poor pupillary reaction
188
Q

meds associated with angle closer glaucoma

A
  • cholinergic meds
  • anticholinergic meds
  • SSRIs
  • antihistamines
  • adrenergic agonists
189
Q

treatment for angle closer glaucoma

A
  • laser peripheral iridotomy
190
Q

macular degeneration

A
  • accumulation of waste products in the eye (drusen)
  • leads to thinning and atrophy of macula
  • neovascularization -> vessels susceptible to rupture
  • visually devistating
191
Q

types of macular degeneration

A
  • dry - without new BV

- wet- with new BV that are very leaky (worse prognosis)

192
Q

risk factors for macular degeneration

A
  • age
  • family history
  • caucasian
  • smoker
  • obesity
  • CV disease
193
Q

sx of macular degeneration

A
  • blurry, distorted vision

- blind spots that move wherever the patient looks

194
Q

management of macular degeneration

A
  • VEGF injections in eye for wet
  • lifestyle changes
  • vitamins
  • photodynamic therapy
  • photocoagulation
195
Q

hypertensive retinopathy

A
  • arteriosclerosis d/t chronically elevated BP
  • > 140/90
  • dev dot hemorrhages and flame hemorrhages
196
Q

signs of hypertensive retinopathy

A
  • widening of arteriole light reflex
  • arteriovenous crossing signs
  • copper or silver wire arteries
  • retinal hemorrhages
  • cotton wool spots
  • exudates (lipids)
  • papilledema
197
Q

diabetic retinopathy

A
  • damage to small blood vessels of eye by sugar in the blood

- blacks, latinos, and native american’s significantly higher risk

198
Q

stages of diabetic retinopathy

A
  • non-proliferative
  • proliferative
  • macular edema (can happen in proliferative or nonproliferative)
199
Q

what does the health of the retina directly reflect?

A
  • kidney health
200
Q

symptoms of diabetic retinopathy

A
  • blurry vision
  • spots or floaters
  • dark spot in vision
  • difficulty seeing well at night
  • occurs as early as A1C of 5.9
  • dev fibrovascular structures which can lead to retinal detachment
201
Q

treatment for diabetic retinopathy

A
  • tight control of sugar and BP
  • anti-VEGF injections
  • steroid injections/ implants
  • laser
  • vitrectomy

Clin Med I (16 decks)

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