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KMK > Ocular Disease > Flashcards

Ocular Disease Flashcards

1
Q

What slit lamp technique is used to evaluate corneal clarity?

A

Sclerotic scatter

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2
Q

What is the set up for sclerotic scatter?

A

60 degrees
Light at the limbus
Parallel piped beam
Naked eye

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3
Q

Which slit lamp technique is used to estimate depth?

A

Optic section

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4
Q

Which slit lamp technique is used to evaluate corneal endothelium?

A

Specular reflection

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5
Q

What type of illumination is used to evaluate non-opaque corneal lesions?

A

Indirect illumination

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6
Q

What filter is used to help detect Fleischer rings?

A

Cobalt blue - no NaFl

-iron rings appear black

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7
Q

Which has a worse prognosis, alkali burns or acidic burns? Why?

A

Alkali burns - they raise tissue pH, breaking down fatty acids in the cell membrane for faster penetration

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8
Q

What is the most common cause of alkali burns?

A

Calcium hydroxide

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9
Q

In a burn, limbal blanching is an indicator of what?

A

Ischemia

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10
Q

What is the typical sign of a corneal abrasion?

A

Corneal defect w/o underlying SEI

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11
Q

Hyphema is usually a result of trauma to what structures?

A

Iris or ciliary body

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12
Q

What exam procedures are contraindicated in a pt with hyphema?

A

Gonio
Scleral depression
-until 1 months post injury

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13
Q

What is hyphema?

A

Blood in the AC

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14
Q

What is a Vossius ring?

A

Pigment ring on the anterior lens, typically due to trauma (iris touching lens)

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15
Q

What may cause an increase in IOP in a pt with hyphema?

A

RBCs clogging the TM

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16
Q

How should pts with significant hyphema be instructed to sleep?

A

Head elevated at 30 degrees

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17
Q

If an idiopathic hyphema presents to you, what tests should be ordered?

A

CBC
Prothrombin time (PT/PTT)
Sickle cell screen
Ask about NSAID use

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18
Q

In orbital wall fractures, what muscle is most likely trapped, causing diplopia in what gaze?

A

Inferior rectus

Upgaze

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19
Q

When may gonioscopy be performed after an orbital fracture?

A

4 weeks after (same for scleral depression)

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20
Q

Commotio Retinae is typically due to trauma, and is a disruption of what parts of the retina?

A

RPE and PR outer segments

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21
Q

How long does commotio retinae take to resolve?

A

Typically 24-48 hours

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22
Q

What is Berlin’s edema?

A

Commotio retinae in the macula

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23
Q

Commotio retinae may or may not be accompanied by what two other conditions that often result from trauma?

A

Retinal hemorrhages

Choroidal rupture

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24
Q

What is iridodialysis?

A

Disinsertion of the iris root from the ciliary body

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25
Q

What type of glaucoma may occur following iridodialysis?

A

Angle recession glaucoma - possible TM damage

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26
Q

What does iridodialysis typically look like on SLE?

A

Peripheral iris hole, best seen with retroillumination

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27
Q

Purtscher’s retinopathy is commonly associated with what?

A

Chest-compressing trauma

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28
Q

What characterizes Purtscher’s retinopathy?

A

Diffuse retinal hemorrhages
Exudates
CWS

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29
Q

What is the typical appearance of choroidal rupture?

A

Single or multiple areas of subretinal hemorrhage, usually within the temporal posterior pole
Crescent shaped tears concentric to the ONH

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30
Q

Choroidal rupture is associated with a long term risk of development of what?

A

CNVM at the margins of the tear

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31
Q

Which ocular structure weakens with age, and may allow orbital fat to prolapse?

A

Septum

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32
Q

Severe prolapsed orbital fat may be a contributing factor to what ocular surface condition?

A

Exposure keratopathy - lid malposition

33
Q

What is the typical demographic and time period of preseptal cellulitis?

A

Children/young adults

Winter months

34
Q

What are the top 3 causes of preseptal cellulitls?

A 
Ocular infection (hordeolum, dacryocystitis)
Systemic infection (URI, middle ear infection)
Skin trauma (insect bite, wound)
35
Q

What are the signs of preseptal cellulitis?

A 
Eyelid edema
Erythema
Ptosis
Warmth
No pain-mild tenderness
Hard eyelid bump
NO orbital congestion
36
Q

What are the 4 most common causes of orbital cellulitis?

A

Sinus infection (ethmoid)
Orbital infection (dacryoadenitis, dacryocystitis)
Orbital fracture
Dental infection

37
Q

What is the most common bacterial culprit of orbital cellulitis in adults?

A

Staph aureus

38
Q

What is the most common bacterial culprit of orbital cellulitis in kids?

A

Haemophilus influenzae

39
Q

What are the symptoms of orbital cellulitis?

A 
Red eye
Pain
Decreased VA
Headache
Fever
Malaise
Reduced color vision
APD
Proptosis
Diplopia
Pain on EOM
EOM restriction
40
Q

What are the signs of orbital cellulitis?

A

Eyelid edema

Redness

41
Q

Orbital cellulitis can result in what other conditions?

A

Cavernous sinus thrombosis
Brain abcess
Meningitis

42
Q

What is the other name for Thyroid Eye Disease?

A

Graves’ disease

43
Q

What is the typical demographic of TED?

A

Female (8:1)

30-40s

44
Q

What is the strongest risk factor for developing TED/Graves?

A

Smoking

45
Q

What is the pathophysiology of Graves/TED?

A

Autoimmune disorder

TSH antibodies attacking EOMs and orbital tissue, causing thickening and compressing the optic nerve

46
Q

What are the symptoms of Graves’?

A 
Prominent eyes
Chemosis
FBS
Tearing
Photophobia
Pain
Diplopia
Decreased VA
Color vision loss
47
Q

What are the signs of Graves’?

A 
Uni or bilateral proptosis
Upper lid retraction
Eyelid erythema and edema
Conj/caruncle injection and edema
Decreased coloar vision
EOM restriction
APD
48
Q

In Graves’, IOP may be elevated in what gazes?

A

Primary

Upgaze

49
Q

What is the most common cause of unilateral or bilateral proptosis in middle-aged patients?

A

Thyroid eye disease

50
Q

What is the NO SPECS grading system of TED?

A

N - No signs/symptoms
O - Only signs, no symptoms
S - Soft tissue involvement (lid edema, conj chemosis)
P - Proptosis
E - EOM involvement (diplopia)
C - Corneal involvement (SPK, SLK, ulcer)
S - Sight loss (nerve compression)

51
Q

What is the order of muscles affected first in TED?

A

Inferior rectus

Medial, superior, and lateral recti

52
Q

What is Von Graefe’s sign?

A

Upper eyelid lag during downgaze

53
Q

What is Dalrymple’s sign?

A

Staring eye - lid retraction

54
Q

What is Kocher’s sign?

A

Globe lag compared to lid movement when looking up

55
Q

What tests can be used for TED diagnosis?

A 
Forced ductions
CT/MRI
Exophthalmometry
VF for optic nerve compression
T3/T4/TSH
56
Q

Carotid-Cavernous fistula results from an abnormal communication between what?

A

Arterial and venous systems

57
Q

Carotid-cavernous fistula most commonly results from what?

A

Closed head trauma

58
Q

What is the clinical triad of carotid-cavernous fistula?

A

Chemosis
Pulsatile proptosis
Ocular bruit

59
Q

What causes the carotid-cavernous fistula triad?

A

High pressure blood from carotid building in the cavernous sinus, impeding the return of venous blood back to the cavernous sinus

60
Q

Beyond the typical triad, what are the other signs of carotid-cavernous fistula?

A 
Episcleral venous congestion
Periorbital tissue swelling
Elevated IOP
Diplopia (CN 3, 4, or 6 palsy)
Loss of lid/face sensation on affected side (CN 5 palsy)
61
Q

What is the most common benign orbital tumor in adults?

A

Cavernous hemangioma

62
Q

What is the typical demographic for cavernous hemangioma?

A

More common in females

30-50’s

63
Q

What characterizes cavernous hemangioma?

A

Progressive, painless, unilateral proptosis

64
Q

Where does a cavernous hemangioma typically arise?

A

Within the muscle cone

65
Q

What is the most common benign orbital tumor in children?

A

Capillary hemangioma

66
Q

What is the most common primary pediatric orbital malignancy?

A

Rhabdomyosarcoma

67
Q

What sign does rhabdomyosarcoma produce?

A

Progressive unilateral proptosis

68
Q

What is the most common secondary pediatric orbital malignancy?

A

Neuroblastoma

69
Q

What is the most common intrinsic tumor of the optic nerve?

A

Optic nerve glioma

70
Q

Infant cases of optic nerve glioma are associated with what in 30-50% of cases?

A

Neurofibromatosis type 1

71
Q

What is the most common benign brain tumor?

A

Meningioma

72
Q

What is the typical demographic of a meningioma?

A

Middle aged women

73
Q

What is the typical demographic of lymphoma?

A

50-70 years old

74
Q

What are the characteristics of lymphoma?

A

APD
Insidious progressive proptosis
VA loss

75
Q

What is a neurofibroma?

A

Benign, yellow-white tumor of astrocytes

76
Q

What is the typical demographic of a neurofibroma?

A

Young to middle-aged adults

77
Q

Where is a neurofibroma typically seen on a CT?

A

Superior orbit

78
Q

What is a neurilemmoma?

A

Benign tumor of Schwann cells

79
Q

A neurilemmoma is most commonly found in what age group?

A

Young to middle aged

KMK (8 decks)

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