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OPHTHO > glaucoma, red eye, pupillary & refractory d/o > Flashcards

glaucoma, red eye, pupillary & refractory d/o Flashcards

1
Q

Marcus gunn

A

decreased DIRECT reaction to light but consensual response intact
swinging flashing test
nerve problem or retinal problem

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2
Q

horner’s syndrome

A

lesion of sympathetic pathway causing miosis, ptosis, no sweating
think tumor, nothing is wrong with eye itself

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3
Q

Argyll robertson

A

pupillary constriction w/ near accommodation but not to light stimulation

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4
Q

4 errors of refraction

A

myopia
hyperopia
presbyopia
astigmatism

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5
Q

myopia

A

nearsightness; eyeball too long that focal point is infront of retina
when object is closer, image can focus on retina but ciliary muscle can’t extend back anymore for farther objects

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6
Q

hyperopia

A

farsightedness; eyeball too short so focal point is behind retina
accommodation is maxed out so lens can’t focus on close objects

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7
Q

presbyopia

A

age-related farsightedness; lens cant change shape for near objects

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8
Q

correction for presbyopia

A

reading glasses or bifocals

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9
Q

astigmatism

A

non-spherical cornea
astigmatic refractive error in cornea so accommodation can’t correct it

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10
Q

correction for astigmatism

A

lenses or refractory surgery

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11
Q

two types of glaucoma

A

primary open-angle & acute angle closure
both involve damage to optic nerve from increased IOP

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12
Q

primary open-angle vs acute angle closure glaucom

A

primary open-angle: chronic, slow progressive & bilateral; no pain; no sx till visual fields are affected
angle-closure: unilateral & sudden onset of severe pain; dilating pupil worsens it; EMERGENCY

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13
Q

which type of glaucoma is worsened when dilated? (via dim lights, cycloplegics, anticholinergics)

A

acute-angle glaucoma

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14
Q

signature visual deficit of glaucoma

A

Halos around light & tunnel vision
NO marcus-gunn

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15
Q

sx of angle-closure glaucoma

A

sudden onset of severe unilateral pain, nausea, vomiting, HA
PE– hazy/steamy cornea, MID-DILATED FIXED pupil, erythema
Eyes feel HARD when palpated

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16
Q

what would a fundoscopic exam reveal with glaucoma?

A

blurred optic disc/cupping of optic nerve

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17
Q

how is angle-closure glaucoma diagnosed? (two ways)

A

tonometry for increased IOP
Gonioscopy to observe narrow chamber

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18
Q

name 4 eyelid inflammation d/o

A

hordeolum/chalazion
blepharitis
ectropion/entropion
dacrystenosis/dacryocystitis

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19
Q

when do you refer a hordeolum/chalazion

A

if sx still there after one month

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20
Q

how do you treat blepharitis

A

scrub w/ baby shampoo
AT & warm compress

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21
Q

how do you treat ectropion & entropions

A

lubricating eye drops & moisture shields
surgery if needed

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22
Q

how do you treat dacryostenosis/dacryocystitis?

A

if its a child– NLD massage
antibiotics (clindamycin, vancomycin + ceftriaxone)
warm compress

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23
Q

when should you refer dacryostenosis

A

if recurrent or not improving

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24
Q

name 6 conjunctival d/o

A

viral conjunctivitis
bacterial conjunctivitis
allergic conjunctivitis
dry eye syndrome
pterygium/pinguecula
subconjunctival hemorrhage

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25
Q

two most common causes of viral conjunctivitis

A

adenovirus & enterovirus

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26
Q

what sx makes viral diff from other forms of conjunctivitis

A

tender enlarged preauricular lymphadenopathy
typically starts in one eye and moves to other

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27
Q

tx for viral conjunctivitis

A

ATs, COOL compress ok

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28
Q

which conjunctivitis requires immediate referral?

A

bacterial conjunctivitis

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29
Q

how is bacterial conjunctivitis diagnosed?

A

fluorescein staining to look for keratitis or corneal abrasions
culture the discharge

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30
Q

sx of bacterial conjunctivitis

A

painless
mucopurulent discharge that can crust over

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31
Q

how is bacterial conjunctivitis tx? what if person wears contacts?

A

topical abx– erythromycin ointment, fluoroquinolones
contact wears– cover pseudomonas w/ ciprofloxacin or topical aminoglycosides

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32
Q

which conjunctival condition is seen in post-menopausal women, systemic conditions like Sjorgen’s pts w/ blepharitis?

A

dry eyes syndrome

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33
Q

pterygium vs pinguecula

A

both dysplastic bulbar conjunctiva & sudden eye pain
pterygium is when it spreads onto the cornea & could affect vision

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34
Q

how are pterygium & pinguecula treated

A

AT for comfort
surgical excision if visually significant pterygium

35
Q

what causes subconjunctival hemorrhages?

A

benign– sneezing, blowing nose, eye rubbing

36
Q

which conjunctival d/o is associated with antiplatelets & anticoagulation

A

subconjunctival hemorrhages

37
Q

sx of subconjunctival hemorrhage

A

Mild FB sensation & NO vision changes

38
Q

what two things should you evaluate for with subconjunctival hemorrhages?

A

blood dycrasias
HTN if recurrent

39
Q

how are corneal abrasions and FB diagnosed?

A

pain improves with proparacaine
fluorescein reveals linear abrasions of epithelial stains/ice-rink

40
Q

common sx of corneal abrasions & FB

A

tearing, red painful eye
photophobia
hard to open eye (blepharospasms)

41
Q

how are corneal abrasions & FB managed?

A

antibiotic drops
erythrmycin ointment,
contacts—-ciprofloxacin or topical aminoglycosides
patch if abrasion is large

42
Q

when should you NOT patch for corneal abrasion or FB?

A

if pseudomonas aeruginosa is suspected

43
Q

what is the biggest risk factor for corneal ulcers? what are the other 2?

A
  1. wearing contacts!
  2. dry ocular surfaces
  3. topical corticosteroid use and immunosuppressants
44
Q

what is a corneal ulcer?

A

serious corneal infection causing white corneal infiltrate
can be sight-threatening
related to hx of FB or trauma

45
Q

Dx of corneal ulcer

A

fluorescein stains the white corneal infiltrate
scrape & culture it

46
Q

sx of corneal ulcers

A

pain, photophobia, redness, vision changes
difficulty keeping eye open

PE– limbal flush, hazy cornea; hypopyon if severe

47
Q

how are corneal ulcers managed?

A

intensive eye drops— moxifloxacin
same day referral!
don’t patch the eye

48
Q

symptoms of herpes simplex/herpetic keratitis

A

pain, photophobia, redness, blurred vision

PE– ciliary flush, hazy cornea, PREAURICULAR node swollen

49
Q

how is herpetic keratitis treated?

A

give topical or oral acyclovir
refer in 1-2 days

50
Q

hallmark of herpes keratitis used to make diagnosis

A

dendritic/branching corneal ulceration w/ fluorescein staining

51
Q

symptoms of herpes zoster

A

hutchingson’s sign– midline painful vesicular rash

52
Q

how is herpes zoster treated

A

oral acyclovir or valacyclovir (rarely IV)
refer for eye movement evaluation

53
Q

what is anterior uveitis/iritis

A

inflammation of the iris or ciliary body

54
Q

how does anterior uveitis react to proparacaine eye drops

A

NO improvement!!

55
Q

what two collagen vascular dz is associated w/ anterior uveitis AND Scleritis

A

RA
lupus
HLA-IBS, sarcoidosis

56
Q

signs of anterior uveitis

A

Unilateral severe ocular pain & photophobia
redness, blurred or decreased vision

PE– perilimbal flush, consensual photophobia, miosis

57
Q

how is anterior uveitis diagnosed?

A

AC cells & flare on slit lamp– haziness d/t proteins in aqueous humor

58
Q

how is anterior uveitis treated?

A

topical glucocorticoids (steroids)
cycloplegics
same day referral

59
Q

what is scleritis & episcleritis

A

autoimmune inflammation of sclera or episclera
vision threatening

60
Q

which is associated w/ systemic connective tissue dz like RA and lupus– scleritis or episcleritis?

A

scleritis!

61
Q

how is cotten tip test used to distinguish between scleritis and episcleritis?

A

with episcleritis, the vessels will move!

62
Q

is scleritis/episcleritis vision threatening?

A

kind of– refer in 1-2 days

63
Q

sx of scleritis vs episcleritis

A

EPIscleritis— focal tenderness, redness, swelling, mild pain
scleritis– deep aching pain, redness; +/- scleral thinning

64
Q

treatment of scleritis vs episcleritis

A

scleritis– systemic immunosuppressants
episcleritis– oral or topical NSAIDs

65
Q

what is hyphema

A

visible blood in anterior chamber of eye

66
Q

what is the most common cause of hyphema?

A

blunt trauma
also related to sickle cell

67
Q

how is hyphema diagnosed?

A

first wanna r/o life or vision threatening injuries
can do CT w/o contrast if globe rupture is suspected

68
Q

how is hyphema treated?

A

eye shield, bed rest, dim lighting
elevate head at least 30 degrees
tetracaine for pain

69
Q

what is hypopyon

A

WBC in anterior chamber; this is a type of anterior uveitis

70
Q

two common causes of hypopyon

A

HLA-B27 associated uveitis is most common
infectious keratitis or endophthalmitis

71
Q

how is hypopyon diagnosed?

A

anterior chamber or vitreous tap for PCR and culture

72
Q

how is hypopyon managed?

A

same day referral
tx underlying cause

73
Q

chemical keratitis

A

alkali/basic is more damaging
red eyes is preferred
if theres white around cornea—stem cell deficiency

74
Q

endogenous vs exogenous endophalmitis

A

infection in eye d/t
endogenous– infection from other body area
exogenous– entry wound after trauma or surgery

75
Q

how is endophalmitis treated?

A

aspiration of ocular fluid for culture
antibiotic injections

76
Q

preseptal vs orbital cellulitis

A

orbital– fat & ocular muscles infected POSTERIOR to orbital septum
preseptal– eyelid & periocular tissue infected ANTERIOR to orbital septum

77
Q

which cellulitis often starts as skin infection, trauma or sinus infection?

A

preseptal

78
Q

which cellulitis could start as preseptal or sinusitis?

A

orbital

79
Q

diagnosis to differentiate between preseptal and orbital cellulitis?

A

CT contrast

80
Q

how do symptoms of preseptal and orbital cellulitis differ?

A

preseptal– NORMAL motility, pupils, VA
orbital– IMPAIRED motility, vision; proptosis, chemosis, RAPD
both: lid edema and erythema

81
Q

which cellulitis should be referred for emergency consultation

A

orbital cellulitis

82
Q

which cellulitis can be drained?

A

ocular

83
Q

what are complications of orbital cellulitis?

A

optic nerve damage, meningitis
cavernous sinus
thrombosis

OPHTHO (6 decks)

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