Ocular disorders Flashcards
Chronic lipogranulomatous inflammation of the meibomian gland
Chalazion
Acute inflammation of the eyelash follicles
Hordeolum
Common infectious agent in hordeolum
Mainly by S aureus
Pt presents with conjunctival hyperemia, eye discharge, foreign body sensation, and photophobia
Conjunctivitis
Conjunctivitis with thick, purulent discharge
Bacterial
Conjunctivitis with watery or mucoid discharge
Viral
Small, raised, yellowish-white hyperplasia of lymphatic tissue in the eye
Conjunctival follicles, seen in viral conjunctivitis
Often due to silver nitrate exposure within 24 hours after birth
Chemical neonatal conjunctivitis
Onset and presentation of gonococcal neonatal conjunctivitis
2-7 days after birth with purulent ocular discharge and pronounced eyelid swelling
Onset and presentation of chlamydial neonatal conjunctivitis
5-23 days after birth with watery/mucopurulent ocular discharge and mild eyelid swelling
Common causal agent of viral neonatal conjunctivitis
HSV II
Onset and presentation of viral neonatal conjunctivitis
Within 14 days after birth with nonpurulent ocular discharge, corneal ulceration, and periocular vesicles
Fibrovascular Ct that migrates on to the cornea, associated with chronic sun exposure
Pterygium
Small, yellowish, submucosal elevation of protein and lipid deposits in the eye that does not invade the cornea
Pinguecula
Fluorescein staining in bacterial keratitis
Round corneal infiltrate or ulcer
Keratitis features in shingles
Punctate or dendritic lesions on the corneal surface
Fluorescein staining in herpes simplex keratitis
Superficial corneal erosions, geographic ulcer
Corneal ring infiltrate, associated with contact lens use
Late-stage acanthamoeba keratitis
Inflammation under an intact corneal epithelium
Stromal/interstitial keratitis
Infective causes of stromal/interstitial keratitis
Syphilis
TB
Leprosy
Pt presents with foreign body sensation, severe ocular pain, photophobia, and blurred vision. They have immigrated from an impoverished country and have had a cough. On exam cornea appears hazy with ground glass/steamy appearance
Stromal/interstitial keratitis
Non-inflammatory corneal condition where it becomes thinner and develops a conic shape, bulging outward at the center
Keratoconus
Conditions associated with keratoconus
Down syndrome
Marfan syndrome
Complication of keratoconus
corneal hydrops –> rupture of descemet membrane
Microscopy shows thinning of the cornea with breaks in the Bowman layer
Keratoconus
Annular deposits of lipids appear around the corneal margin, associated with normal aging.
Arcus senilis/corneal arcus
Green-brown, copper deposits within Descemet’s membrane, associated with Wilson disease
Kayser-Gleischer ring
Disease associated with Kayser-Gleischer ring
Wilson disease
Earliest manifestation of vit A deficiency
Night blindness and impaired vision
Epithelial metaplasia and keratinization of eye with xerophthalmia, Bitot spots, keratomalacia.
Vit A deficiency
Characterized by optic disc atrophy with cupping
Glaucoma
Progressive visual field loss starting with peripheral vision until tunnel vision
Open angle/primary glaucoma
General secondary cause of open angle glaucoma
Blocked trabecular meshwork from debris
Primary cause of angle-closure glaucoma in elderly
Thickness of lens increases with age
Secondary causes of angle-closure glaucoma
Neovascular glaucoma (DM)
Scaring
Lens dislocation
Mydriatic agents
Pt presents with sudden acute loss of vision, unilateral inflamed and painful eye, frontal HA, blurred vision, and halos around light.
Closed angle glaucoma
Reduced aqueous outflow leading increase in intraocular pressure that compresses retinal blood supply with optic dis atrophy and cupping
Glaucoma
Cholinergic agent for glaucoma
Pilocarpine
Acts on M3 receptors to cause contraction of sphincter pupillae and longitudinal ciliary muscle to increases trabecular outflow
Pilocarpine
Adverse effects of Pilocarpine
Superficial punctate keratitis
Brow ache
Induced myopia
Increased risk of retinal detachment
Iritis
Most widely used ocular hypotensive agent
Timolol
Conditions that contraindicate use of Timolol in glaucoma
COPD
Asthma
HF
Selective beta-1-blocker used for glaucoma
Betaxolol
Beta-blocker used in glaucoma with an additional neuroprotective effect
Betaxolol
Mechanism of beta-blockers in treating glaucoma
Decreases aqueous humor production by blocking beta receptors on ciliary epithelium
Nonselective adrenergic agents used in treating glaucoma
Epinephrine
Dipvefrin
Prodrug of epinephrine with an increased penetration to the anterior chamber of the eye
Dipivefrin
Mechanism of Dipivefrin
Increased uveoscleral outflow
Selective alpha-2 agonists used in glaucoma
Brimonidine
Apraclonidine
Drug used short term for post op rise in intraocular pressure
Apraclonidine
Selective alpha-2 agonist with an additional neuroprotective effect
Brimonidine
Drug used for glaucoma in pts with contraindications to beta blockers
Brimonidine
Mechanism of alpha-2 agonists for glaucoma
Decrease aqueous humor production by alpha-2 action on ciliary epithelium
Prostaglandin analogues used to treat glaucoma
Latanoprost
Unoprostone
Bimatoprost
Travoprost
Adverse effects of latanoprost
Conjunctival hyperemia
Iris pigmentation
cystoid macular edema
Prostaglandin analogue with an additional neuroprotective effect by increasing microcirculation in optic nerve head
Unoprostone
First line drug class for open angle glaucoma
Prostaglandin analogue
Mechanism of prostaglandin analogues in glaucoma
Decrease IOP by increasing uveoscleral outflow
Systemic carbonic anhydrase inhibitors used in glaucoma
Acetazolamide
Methazolamide
Drug class that blocks CA enzyme reversibly in ciliary body, limits generation of bicarbonate ion, and reduces aqueous humor production. Used to treat glaucoma.
Systemic carbonic anhydrase inhibitors
Topical carbonic anhydrase inhibitors used to treat glaucoma
Dorzolamide
Brinzolamide
Advantage of dorzolamide
Not absorbed systemically
Adverse effects of dorzolamide
Corneal edema
Allergic reaction
Burning and stinging sensations
Osmotic agents used to treat glaucoma
Glycerine
Mannitol
Mechanism of osmotic agents in glaucoma
Increases shift of water into the intravascular space to decrease IOP
Types of optic neuritis
Retrobulbar
Intrabulbar neuritis/papillitis
Most common cause of optic neuritis
MS
Infections associated with optic neuritis
Lyme disease
Syphilis
Toxin associated with optic neuritis
Methanol
Pt presents with blurry vision, sudden vision loss, central scotoma, and retrobulbar pain.
Optic neuritis
Inherited optic neuritis
Leber hereditary optic neuropathy
Inflammatory disorders associated with anterior uveitis
Sarcoidosis
RA
Juvenile idiopathic arthritis
Slit-lamp examination shows hypopyon
Non-granulomatous uveitis
Hypopyon
Collection of pus in anterior chamber of eye
Findings in granulomatous uveitis
Large keratic precipitates
Bilateral granulomatous panuveitis after penetrating injury or surgery beginning several weeks to a year after trauma
Sympathetic ophthalmia
Patient presents with floating spots, reduced vision, pain in both eyes, and increased sensitivity to light. Eye trauma occurred several months ago.
Sympathetic ophthalmia
Complication of sympathetic ophthalmia
Bilateral blindmess
T cell mediated autoimmune response to retinal antigens
Sympathetic ophthalmia
Treatment for sympathetic ophthalmia
Systemic immunosuppressant
Lens of eye becomes cloudy and opaque, most often with increasing age
Senile cataract
Key sign in senile cataract
Loss of red reflex
Leading cause of blindness in those <65 yo in developed countries
Macular degeneration
Elderly pt present with gradual, painless, bilateral vision loss
Macular degeneration
Accumulation of EC deposits (drusen) underneath the retinal pigment epithelium due to oxidative damage
Dry/non-exudative macular degeneration
Growth of neovascular vessels from choroid that proliferate underneath the retinal pigment epithelium and defects in Bruch’s membrane. Leakage produces elevation of retina causing metamorphopsia and blurring.
Wet/exudative macular degeneration
Early sign of wet AMD
Scotoms
Late-sign of wet AMD
Straight lines appear wavy
General treatment for wet AMD
Intraocular injection of VEGF antagonists
VEGF antagonists used in AMD
Bevacizumab
Ranibizumab
Aflibercep
Sudden and painless loss of vision in one eye
Vessel occlusion
Fundoscopy findings in central retinal A occlusion
Cherry-red spot at fovea centralis
Fundoscopy findings in central retinal V occlusion
Flame-shaped hemorrhages
Tortuous veins
Papilledema
Pt presents with asymptomatic gradual reduction in vision with normal lens and cornea
Retinopathy
Retinopathy grade with focal narrowing or arterioles and mild A-V nicking
Grade 1
Retinopathy grade with arteriole narrowing, copper wiring, and more accentuated A-V nicking
Grade 2
Retinopathy grade with arteriole narrowing, silver wiring, flame-shaped and dot-blot hemorrhages, soft cotton wool spots, hard exudates, and normal disc.
Grade 3
Retinopathy grade with fine, fibrous arterioles, silver wiring, flame-shaped and dot-blot hemorrhages, soft cotton wool spots, hard exudates, normal disc, and papilledema.
Grade 4
Two types of diabetic retinopathy
Non-proliferative/early
Proliferative/late
Wet retinopathy is associated with this underlying condition
Diabetes
Risk factor for developing retinopathy of prematurity
Treatment with hyperbaric oxygen therapy in premature infants with hyaline membrane disease
Retinal ischemia, upregulation of VEGF-retinal angiogenesis, formation of fibrovascular membranes, and retinal detachment
Retinopathy of prematurity
Most common primary intraocular malignancy in adults
Uveal melanoma
Risk factors for uveal melanoma
Uveal nevus
Light skin color
Light color of iris
Fundoscopy findings in uveal melanoma
Pigmented lesion near temporal margin of the optic disc
Histology of ocular lesion shows large cells, vesicular nucleus, prominent nucleolus, with cytoplasmic melanin pigment
Uveal melanoma
Most common primary intraocular malignancy of children
Retinoblastoma
Mutation associated with retinoblastoma
RB on chromosome 13
Other cancers associated with retinoblastoma
Osteosarcoma
Pinealoma
Child presents with leukocoria and progressive or sudden loss of vision
Retinoblastoma
Features of leukocoria
Cat’s eye pupil
White pupillary reflex
Strabismus
Cause of progressive loss of vision in retinoblastoma
Due to tumor infiltration into the macula or vitreous humor
Cause of sudden loss of vision in retinoblastoma
Retinal detachment
Histology shows small, round, blue cells with hyperchromatic nuclei and scanty cytoplasm. With rosettes and fleurettes, necrosis, and dystrophic calcification
Retinoblastoma
Generalized reduction of visual acuity with starburst around lights
Cataract