Ocular Disease Flashcards
Arlt’s line
Scarring on upper cornea
* in trachoma
Signs of trachoma
- Art’s line (scarring on upper cornea)
- Herbert’s pits (follicles on/around limbus)
Testing for preseptal cellulitis
- Optic nerve (no involvement)
- EOMS (no restrictions, if there is pain/restrictions=orbital cellulitis)
- Proptosis exophthalometer
- Fever and headaches
Tx for EKC
Cold compress
Good hygiene + pt education
* epidemic keratoconjunctivitis self resolving 2-3 weeks
* caused by adenovirus, transmitted via secretions (respiratory, ocular)
Which disease causes s-shaped ptosis?
Acute Dacryocystitis
* infection and/or inflammation of the lacrimal gland and can result in acute swelling and discomfort in upper lateral eyelid
Infectious agent of canaliculitis
Actinomyces Israeli
What is the estimated percentage of chemical ocular burns that occur in industrial settings?
66%
This statistic highlights the prevalence of chemical burns in occupational environments.
Name three symptoms of chemical burns.
- Normal or decreased vision
- Pain
- Foreign body sensation
Additional symptoms may include photophobia, tearing, and blepharospasm.
What are some signs of corneal damage in chemical burns?
- Mild superficial punctate keratitis (SPK)
- Sloughing off of the entire epithelium
- Conjunctival injection
- Chemosis
- Ciliary injection
- Anterior chamber reaction
- Conjunctival hemorrhages
- Scleral and limbal blanching
Severe burns may also increase intraocular pressure (IOP).
True or False: Alkali burns have a better prognosis than acidic burns.
False
Alkali burns raise tissue pH, leading to more severe damage.
Fill in the blank: Alkali burns are ______ compared to acidic burns because they raise tissue pH.
worse
This is due to the breakdown of fatty acids in cell membranes.
What are common alkali agents that can cause chemical burns?
- Ammonia
- Lye
- Magnesium hydroxide
- Lime
- Airbag residue
These substances are often found in household or industrial products.
List two common acidic agents that can cause chemical burns.
- Hydrofluoric acid
- Sulfuric acid
Other examples include nitric acid, chromic acid, and PAVA spray.
What is a notable characteristic of alkali burns regarding penetration?
Faster penetration (often less than 1 minute)
This rapid penetration contributes to the severity of the injury.
What symptom may indicate severe chemical burns?
Increased intraocular pressure (IOP)
Severe burns can lead to complications affecting eye pressure.
Limbal blanching is a sign of _____ and is most common in alkali burns
Ischemia
* alkali injuries are more dangerous than acidic injuries
Symptoms of corneal abrasion
- Sharp pain (esp. after blinking)
- FBS
- photophobia
- tearing
- blurred vision
- mild anterior chamber reaction
- miotic pupil
Epidemiology of corneal abrasion
History of trauma (fingernail, tree branch)
What is retinoblastoma?
The most common primary intraocular malignancy in children
It represents about 3-4% of all childhood cancers.
What percentage of childhood cancers does retinoblastoma represent?
About 3-4%
This indicates its relative frequency among childhood cancers.
What is the incidence rate of retinoblastoma?
Occurs in about 1 in 17,000 live births
This statistic highlights its rarity.
At what age do most children present with retinoblastoma?
Before the age of 3
About 80% of diagnosed cases occur before this age.
Is an initial diagnosis of retinoblastoma over the age of 6 common?
Extremely rare
This underscores the typical age range for diagnosis.
What is the most common intraocular malignancy in adults?
Melanoma
This contrasts with retinoblastoma, which is primarily seen in children.
What is phacomorphic glaucoma?
An acute secondary angle-closure type of glaucoma caused by antero-posterior growth and anterior movement of the crystalline lens
This leads to increased iridolenticular contact, pupillary block, and iris bombe.
What are the consequences of untreated phacomorphic glaucoma?
Significantly elevated intraocular pressure and severe damage to the optic nerve
Immediate treatment is crucial to prevent optic nerve damage.
What triggers phacolytic glaucoma?
High molecular weight proteins leaking into the anterior chamber from a hypermature cataractous crystalline lens
These proteins obstruct the trabecular meshwork.
What is the result of obstruction in phacolytic glaucoma?
Significant elevation in intraocular pressure and eventual optic nerve damage
Efficient and effective treatment is necessary.
What characterizes Posner-Schlossman syndrome?
Recurrent acute attacks of anterior uveitis with elevated intraocular pressure
Presumed to be due to acute trabeculitis.
What is phacoanaphylactic uveitis?
An autoimmune reaction secondary to proteins leaking from a lens with a ruptured capsule
This condition can lead to inflammation and other complications.
Fill in the blank: Phacomorphic glaucoma is considered an acute secondary _______ type of glaucoma.
angle-closure
True or False: Phacolytic glaucoma can occur due to the leakage of low molecular weight proteins from the lens.
False
What morphological changes contribute to phacomorphic glaucoma?
Antero-posterior growth and anterior movement of the crystalline lens
These changes increase iridolenticular contact.
Fill in the blank: In Posner-Schlossman syndrome, elevated intraocular pressure is presumed to be due to _______.
acute trabeculitis
What can happen if phacolytic glaucoma is not treated efficiently?
Optic nerve damage
ROP occurs due to?
Infants exposed to high oxygen concentrations
* causes vasoconstriction of immature peripheral retinal blood vessels
* subsequent removal of oxygen leads to hypoxic state in retinal periphery and proliferation of new, abnormal, leaky blood vessels (neovasc)
What is scleritis?
An inflammation of the sclera that generally occurs as a result of a systemic condition, usually of collagen vascular origin, most commonly rheumatoid arthritis.
Scleritis can also be induced post-surgically or occur secondary to infections such as corneal ulcers or trauma.
What are the two types of scleritis?
Diffuse scleritis and nodular scleritis.
Anterior necrotizing scleritis is another variant, which can be with or without inflammation.
What are the common symptoms associated with scleritis?
Ocular injection and pain, extreme ocular pain, and mild symptomology in some cases.
Pain may radiate to the jaw, brow, and forehead.
Describe the pain experienced in anterior necrotizing scleritis with inflammation.
Extreme ocular pain that may awaken the patient at night; described as boring and may radiate to the jaw, brow, and forehead.
This type of scleritis has significant inflammation.
What is scleromalacia perforans?
A form of anterior necrotizing scleritis without inflammation where patients may report only mild symptoms.
It is characterized by scleral thinning.
What clinical sign is associated with diffuse scleritis?
Sectoral or diffuse inflammation of the episcleral, conjunctival, and scleral vessels with distortion of the scleral vasculature.
This indicates a widespread inflammatory response.
What characterizes nodular scleritis?
Presents with a scleral nodule that is typically inflamed and non-moveable.
Nodules are a key feature of this type of scleritis.
What happens to the scleral vasculature in anterior necrotizing scleritis with inflammation?
The scleral vasculature may become necrotic, leading to ulcerated conjunctiva.
Over time, the uvea becomes more visible through areas of thinned sclera.
What is a potential complication of severe scleral thinning?
A staphyloma may form.
This is a bulging of the sclera that can occur due to weakness in the scleral structure.
What is the most severe form of scleritis?
Anterior Necrotizing Scleritis With Inflammation
This form has a higher mortality rate than other types due to its association with autoimmune diseases.
How does scleritis typically present?
Bilateral, but may also be unilateral
Most cases of scleritis are bilateral.
What should be evaluated in the sclera during an examination?
A blue hue, indicating previous episodes and scleral thinning
The sclera should be examined in natural light and in all fields of gaze.
What is the significance of a dilated fundus exam in scleritis?
To rule out posterior pole involvement
This exam is critical for assessing potential complications.
What may extend to the uvea in scleritis?
Inflammation, causing associated anterior uveitis
Persistent uveitis can lead to complications like cataract, glaucoma, or macular edema.
What is Scleromalacia Perforans?
Anterior Necrotizing Scleritis Without Inflammation
Patients typically do not experience pain or inflammation.
How does scleromalacia perforans typically present?
Typically bilateral with patches of thinned sclera
The patches are surrounded by non-inflamed tissue.
What happens to the underlying uvea in scleromalacia perforans?
Becomes progressively more visible with increasing coalescence of necrotic tissue
This condition is commonly observed in patients with rheumatoid arthritis.
What is the risk of perforation in scleromalacia perforans?
Rare
Although staphyloma formation may occur, perforation is uncommon.
What are the first-line treatments for diffuse and nodular scleritis?
Oral NSAIDs such as indomethacin, flurbiprofen, or ibuprofen
Indomethacin is typically 25 mg t.i.d., flurbiprofen 100 mg t.i.d., and ibuprofen 400-600 mg q.i.d.
What may be prescribed if NSAIDs are ineffective?
Oral steroids such as prednisolone
Prednisolone is often prescribed at 40-80 mg q.d., tapered over weeks to months.
What is occasionally required in the treatment of scleritis?
Concurrent use of lower-dose oral steroids and oral NSAIDs
This combination may be necessary for effective management.
What are the initial treatment options for necrotizing scleritis?
Oral steroids, oral NSAIDs, or a combination of the two
What may be necessary if oral steroids prove to be ineffective in treating necrotizing scleritis?
IV corticosteroids
What type of therapy may be required for very severe cases of necrotizing scleritis that do not respond to steroids?
Immunosuppressive therapy, such as methotrexate, cyclosporine, azathioprine, or cyclophosphamide
When might a patch graft be required in the treatment of necrotizing scleritis?
If there is a risk of perforation
Are topical steroids generally effective in treating necrotizing scleritis?
No, they are generally ineffective
Why are subtenon steroid injections typically contraindicated in necrotizing scleritis?
Due to the increased risk of perforation from tissue thinning
What should be attempted in patients with diffuse anterior scleritis?
Determine if there is a systemic cause associated with the scleritis
Name three common causative conditions for diffuse anterior scleritis.
- Rheumatoid arthritis
- Systemic lupus erythematosus
- Relapsing polychondritis
What are other conditions that frequently develop anterior diffuse scleritis?
- Inflammatory bowel disease
- Ankylosing spondylitis
- Reiter’s syndrome
List two infectious causes associated with anterior diffuse scleritis.
- Herpes zoster
- Syphilis
What granulomatous disease is associated with anterior diffuse scleritis?
Sarcoidosis
What metabolic diseases are commonly associated with anterior diffuse scleritis?
- Diabetes mellitus
- Gout
What should be done to reduce the risk and/or severity of future manifestations of scleritis?
Treat the underlying systemic cause
True or False: Recurrences of scleritis are uncommon.
False
What is important to refer patients with diffuse scleritis for?
Systemic work-ups
What are optic disc hemorrhages commonly associated with?
Normal tension glaucoma
Optic disc hemorrhages are typically found at the margin of the optic nerve in patients with normal intraocular pressures.
Where do Drance hemorrhages typically appear?
At the edge of the optic disc
Drance hemorrhages extend onto the nerve fiber layer.
In which quadrant of the optic nerve head are optic disc hemorrhages most often found?
Infero-temporal quadrant
This location is common for the occurrence of these hemorrhages.
What is thought to cause optic disc hemorrhages in patients with normal intraocular pressures?
Vascular insufficiency or low systemic blood pressure
These conditions can lead to decreased ocular perfusion pressure.
What may manifest several months after an optic disc hemorrhage?
Nerve fiber layer defect and/or visual field defect
These defects correspond to the location of the previous hemorrhage.
True or False: Optic disc hemorrhages are more commonly observed in individuals with elevated intraocular pressures.
False
They are more commonly observed in individuals exhibiting normal intraocular pressures.
Fill in the blank: Optic disc hemorrhages typically extend onto the _______.
nerve fiber layer
This extension characterizes Drance hemorrhages.
What are conjunctival follicles?
Discrete, pale yellowish-white, round elevations in the conjunctival fornices
Follicles typically range from 0.5 to 2.0mm in diameter and are associated with various conjunctival conditions.
What is the typical size range of conjunctival follicles?
0.5 to 2.0mm in diameter
The size can vary depending on the severity and duration of the disease.
What conditions commonly feature a follicular response?
- Viral conjunctivitis
- Chlamydial conjunctivitis
- Parinaud’s oculoglandular syndrome
- Hypersensitivity reactions to topical medications
These conditions may trigger the formation of conjunctival follicles.
Where are conjunctival papillae typically located?
Areas where the conjunctiva is attached to the deeper fibrous layer, like the tarsal conjunctiva and limbal bulbar conjunctiva
Papillae are distinct from follicles due to their location.
What do smaller micropapillae look like?
Polygonal, elevated, red dots less than 1mm in size
They form a mosaic pattern.
What is a key structural feature of conjunctival papillae?
Central fibrovascular core that arborizes as the vessel reaches the surface
This core distinguishes papillae from follicles.
What can lead to papillary reactions in the conjunctiva?
- Allergic conjunctivitis
- Bacterial conjunctivitis
- Contact lens wear
- Chronic blepharitis
- Superior limbic keratoconjunctivitis
- Floppy eyelid syndrome
These factors can stimulate the formation of papillae.
True or False: Conjunctival follicles contain a vascular core.
False
Follicles do not contain a vascular core; blood vessels sweep over their surface.
Fill in the blank: Conjunctival papillae are typically found where the conjunctiva is attached to the __________.
[deeper fibrous layer]
This attachment is crucial for the formation of papillae.
What is metamorphopsia?
A type of visual distortion where perceived linear images appear wavy or broken
Commonly occurs in macular diseases such as macular degeneration, clinically significant macular edema, and central serous retinopathy
How do clinicians typically test for metamorphopsia?
Using an Amsler Grid
The Amsler Grid is a tool used to detect visual distortions and changes in central vision
What is micropsia?
A type of visual distortion where images appear decreased in size
Caused by the spreading apart of foveal cones
What is macropsia?
A perceived increase in image size
Results from a crowding together of foveal cones
Are micropsia and macropsia common visual symptoms?
No, they are very uncommon
Both conditions are rare visual distortions
What is photopsia?
A perceived flash of light
Can be associated with traction of the retina in cases of a retinal break, tear, or detachment, or most commonly, a posterior vitreous detachment
What are scotomas?
Areas of the visual field where vision is partially or entirely degenerated
Scotomas can vary in size and shape and can be caused by various ocular conditions
In general, how is IOP affected in patient with idiopathic anterior uveitis?
IOP is typically decreased
* because ciliary body decreases its production of aqueous when inflamed
BUT if TM gets blocked by cells and flare it can increase IOP
Which organism is the MOST frequent to cause CL-associated keratitis?
Pseudomonas aeruginosa
*must treat quickly, enzymes can easily liquefy cornea in 1-2 days time
What is epidemic keratoconjunctivitis (EKC)?
A very common and contagious infection of viral etiology
What virus causes epidemic keratoconjunctivitis?
Adenovirus, particularly serotypes 8 and 19
What is the ‘Rule of 8s’ in relation to EKC?
Serotype 8 is the type most frequently isolated and symptoms appear on the 8th day
What is the typical progression of symptoms in EKC?
Diffuse superficial punctate keratitis on day 8, followed by sub-epithelial infiltrates on day 16
When is a patient with EKC considered no longer contagious?
Once sub-epithelial infiltrates (SEIs) are present
What are common signs of EKC?
Follicular conjunctivitis, positive lymphadenopathy, mild lid edema
What are some additional symptoms that may be present in EKC?
Small sub-conjunctival hemorrhages, pseudo-membranes, and iritis
What is the general treatment approach for EKC?
Palliative treatment including ocular lubrication, topical vasoconstrictors, cool or warm compresses, topical NSAIDs, and sunglasses
What off-label treatment is sometimes used for EKC?
Betadine® (5%) in office treatment
Why is the use of steroids in EKC controversial?
EKC and Herpes simplex virus (HSV) can initially present similarly, and steroid use on HSV can lead to corneal damage
When are topical steroids effective in EKC?
If the patient suffers from visually debilitating sub-epithelial infiltrates
What is vernal conjunctivitis?
A severe form of allergic conjunctivitis observed in young males with atopy
What is the main symptom of vernal conjunctivitis?
Severe itching
How does bacterial conjunctivitis typically present?
Starts in one eye and can spread to the other via self-inoculation
What type of discharge is commonly associated with bacterial conjunctivitis?
Mucopurulent discharge
Does bacterial conjunctivitis affect the pre-auricular nodes?
No, except in hyperacute bacterial conjunctivitis caused by N. gonorrhoeae
What is phlyctenulosis?
A hypersensitivity reaction to microbes or their by-products
What commonly causes phlyctenulosis?
Staphylococcus exotoxins
What is the presentation of phlyctenulosis?
A pink elevated nodule of tissue on the conjunctiva or cornea
What symptoms do patients with phlyctenules typically complain of?
Pain and irritation
Do pre-auricular nodes get involved in phlyctenulosis?
No, they remain uninvolved
What is oculoglandular syndrome?
A condition that typically presents as unilateral follicular conjunctivitis along with lymphadenopathy on the same side as the affected eye.
What are common etiologies of oculoglandular syndrome?
- Cat-scratch disease
- Tularemia
- Syphilis
- Tuberculosis
- Sporotrichosis
- Mononucleosis
- Coccidioidomycosis
- Sarcoidosis
- Hansen’s disease
- Mumps
- Actinomycosis
- Listeria
- Herpes simplex
What is the most common cause of oculoglandular syndrome in children?
Cat-scratch disease.
How can cat-scratch disease be verified in a child?
By asking if the child had recently been scratched by a cat and performing the Hanger-Rose skin test.
How is coccidioidomycosis contracted?
Through exposure to a fungus found in soil and vegetables via an opening in the skin.
Who is most likely to contract coccidioidomycosis?
Gardeners, farm workers, or botanists.
Do diabetes, measles, and toxoplasmosis correlate with the development of oculoglandular syndrome?
No, they do not display a correlation.
Fill in the blank: Oculoglandular syndrome typically presents as a unilateral follicular conjunctivitis along with _______.
lymphadenopathy on the same side as the affected eye.
True or False: Oculoglandular syndrome can be caused by a single organism.
False.
What is apoptosis?
The process of programmed cell death
Apoptosis is a natural process that helps regulate cell populations and can prevent tumor formation.
What is necrosis?
Premature death of living cells and tissues
Necrosis is usually caused by external factors like infection, trauma, or toxins.
What are the typical causes of apoptosis?
Natural processes within the body
Apoptosis is generally a beneficial process for tissue health.
What are the typical causes of necrosis?
External factors such as infection, trauma, or toxins
Necrosis is detrimental to tissue health.
How does apoptosis affect tumor formation?
It can prevent tumor formation by balancing cell death rate and mitosis rate
This balance is crucial for maintaining healthy tissue homeostasis.
What is a characteristic feature of necrosis?
Results in inflammation of surrounding tissues
This inflammation can become chronic, leading to further tissue damage.
What is autolysis?
Destruction of a cell by means of its own enzymes
Commonly known as self-digestion.
What is phagocytosis?
The process by which a cell engulfs a particle, forming a phagosome
This process is crucial for immune response and cellular cleanup.
True or False: Apoptosis is detrimental to tissue.
False
Apoptosis is generally regarded as beneficial to tissue health.
Fill in the blank: Necrosis is caused by _______ factors.
external
These factors can include infection, trauma, or toxins.
