Lecture 1: Intro to Ophthalmology

Question 1

What are the 3 layers of the eye?

Answer 1

Fibrous: Sclera and Cornea
Vascular: Iris, pupil, ciliary body, choroid
Neural: Retina, photoreceptors, optic nerve

Question 2

What kind of humor fills the anterior and posterior sections of the eye?

Answer 2

Anterior: Aqueous humor
Posterior: Vitreous humor

Question 3

What are the macula and fovea?

Answer 3

Macula: pigmented center of the retina.
Fovea: Center of the macula itself. Highest area of visual acuity.

Question 4

When I look at something close by, what happens to my lens?

Answer 4

It gets thicker.

Question 5

What are the focal point and refraction?

Answer 5

Focal point: where light focuses on the retina. Good vision requires a focal point precisely on the retina.

Refraction: Bending light to produce a focused image on the retina.

Question 6

What is myopia and how is it corrected?

Answer 6

Myopia is nearsightedness, so you require a concave lens to diverge the light. It will make objects smaller than they appear.

Question 7

What is the mnemonic for myopia vs hyperopia?

Answer 7

Need Medical Doctors for Healthy Children.
Near Myopia diverging
Far Hyperopia converging

Question 8

What is hyperopia and how is it corrected?

Answer 8

Farsightedness, aka nearby objects look blurry.
The lens is focusing light past the retina.

Corrected via a convex lens to magnify objects.

Question 9

What kind of lens is a magnifying glass?

Answer 9

Convex. Focuses light to a closer point.

Question 10

What is the mnemonic to remember a concave lens’ refraction?

Answer 10

Cave diver.
Concave divergent.

Question 11

What is astigmatism?

Answer 11

Light reflecting to multiple focal points.
It is caused by irregular cornea/lens shape.

Question 12

What is presbyopia?

Answer 12

Age related farsightedness.
Loss of mobility and focusing power of lens.
Requires reading glasses to correct.

Question 13

What is keratoconus?

Answer 13

Thinning of cornea, resulting in blurred vision, photosensitivity, and glare. Unknown etiology, but often pts have hx of corneal transplants or vision correction.

Question 14

What are the two photoreceptors of the retina? Which one does what?

Answer 14

Cones = color (RGB)
Rods = black and white

Question 15

What two parts of the eye lack blood vessels?

Answer 15

Cornea and Lens

They get their nutrients from aqueous humor.

Question 16

What is the main purpose of aqueous humor? What makes it?

Answer 16

Maintaining intraocular pressure.
Made by the ciliary body.

Question 17

What is the main purpose of vitreous humor?

Answer 17

Maintaining eyeball shape and holding lens in place.
More jelly-like.

Question 18

What is glaucoma characterized by exam wise?

Answer 18

Cupping of the optic desk on ophthalmic exam.

Question 19

What is the leading cause of blindness? Second?

Answer 19

Leading: CATARACTS
second: glaucoma

Question 20

What part of the nervous system controls pupillary dilation and constriction?

Answer 20

Dilation = Sympathetic
Constriction = Parasympathetic

Question 21

What is anisocoria?

Answer 21

One pupil larger than the other.

Question 22

What is a marcus gunn pupil/relative afferent pupillary defect? (RAPD)

Answer 22

Normal consensual response.
NO DIRECT response.

Question 23

What is Horner’s triad?

Answer 23

PAM Horner
Ptosis
Anhidrosis
Miosis (excessive pupillary constriction)

Miosis is most apparent in dim light.

Question 24

What physical feature would make us suspect Horner’s syndrome?

Answer 24

Associated heterochromia (diff eye colors)

Question 25

What is adie's pupil/tonic pupil?

Answer 25

Slow or lack of pupillary reaction to light. Often associated with diminished DTRs. (Holmes-Adie syndrome) Common in women 30-40.

Question 26

What is argyll-robertson pupil?

Answer 26

Pupils restricting only to accommodation but not light. Hallmark of tertiary syphilis!!!! | Usually bilateral. ## Footnote ARP (Accomodation reflex present. Pupillary reflex absent!)

Question 27

What is the most common exam finding for cataracts?

Answer 27

No red reflex.

Question 28

What non-eye chronic conditions can prompt a fundoscopic exam?

Answer 28

HTN Diabetes

Question 29

What are cotton wool spots and what causes them?

Answer 29

Soft exduates, like clouds on the retina. MC: Diabetic retinopathy and HTN retinopathy.

Question 30

What is retinal detachment often described as and what is the MC?

Answer 30

Like a curtain coming down on the eye. MC: Diabetic neuropathy.

Question 31

How does papilledema present?

Answer 31

* Ill-defined margins * Disc elevation * Venous distension and tortuosity * Obscured disk * Lack of venous pulsations

Question 32

How does retinal vein occlusion often present?

Answer 32

Widespread hemorrhaging, creating a blood and thunder fundus.

Question 33

What exam finding is highly suggestive of a central retinal artery occlusion?

Answer 33

Red cherry spot on the fovea. ## Footnote Also boxcar segmentation

Question 34

What is A-V nicking? MC?

Answer 34

Artery crossing vein. Compresses small vein. MC: HTN retinopathy.

Question 35

What condition is the MC for copper and silver wiring?

Answer 35

HTN retinopathy

Question 36

What is copper and silver wiring?

Answer 36

Atherosclerotic vessel wall thickening and chronic HTN. Copper is the early stages. Silver is late stages.

Question 37

What are hard exudates? MC?

Answer 37

Small, white/yellow blotches with distinct borders. Diabetic retinopathy.

Question 38

What are flame hemorrhages? MC?

Answer 38

Necrotic vessels bleeding into the nerve fiber layer. Diabetic/HTN retinopathy

Question 39

What are dot-blot aneurysms?

Answer 39

Microaneurysms erupting in deep retina.

Question 40

What is neovascularization? MC?

Answer 40

Ischemia/damage causing VEGF release. Many new vessels forming. Diabetic retinopathy and macular degeneration

Question 41

What is retinal drusen? MC?

Answer 41

Yellow deposits under the retina, mainly in the macular region. Age-related macular degeneration (AMD)

Question 42

What differentiates hard exudates from retinal drusen?

Answer 42

Retinal drusen is macula centered. Hard exudates are typically spread out everywhere.

Question 43

What is a slit lamp usually used to examine?

Answer 43

Anterior chamber of the eye.

Question 44

What is a fluorescein stain usually used to check for?

Answer 44

Corneal abrasions, ulcers, and foreign bodies.

Question 45

What are the steps to check for a corneal abrasion?

Answer 45

1. Instill tetracaine to numb eye 2. Apply fluoroscein stain to eye 60s later, ask pt to blink a few times. 3. Use a wood's lamp or cobalt blue filter. 4. Uptake indicates corneal abrasion