OnlineMedEd: Surgery: Subspecialty - "Adult Ophtho"

Question 1

Describe the basic pathophysiology of closed-angle glaucoma.

Answer 1

When the eye dilates, as in a low-light condition, the iris blocks the outflow of fluid. Pressure builds up and causes extreme eye pain and headache.

Question 2

How is closed-angle glaucoma definitively diagnosed?

Answer 2

Measuring the pressure of the eye

Question 3

Closed-angle glaucoma is treated with ______________.

Answer 3

(1) pupillary constrictors and (2) laser iridotomy

Question 4

Which drugs are used to induce pupillary constriction in closed-angle glaucoma?

Answer 4

Alpha agonists (brimonidine) and beta blockers (timolol)

Remember the Sketchy scenes: the alpha-2 agonists are pouring the eye bottle onto the fire, symbolizing increased outflow; the beta-2 agonists are filling up an eye balloon, symbolizing increased inflow (which you want to decrease).

Question 5

Never give _____________ to patients with a history of glaucoma.

Answer 5

antimuscarinics (atropine, scopolamine, tolterodine, oxybutynin, ipratropium, tiotropium)

Question 6

Review the key question you need to ask in evaluating periorbital cellulitis.

Answer 6

“Can the person move his/her eye?”

• If no, get a CT for evaluation of orbital cellulitis (which would require incision and drainage.
• If yes, give antibiotics for a normal skin infection.

Bonus points: “Does the person have DKA?” A positive here would lead you to rhinocerebral mucormycosis.

Question 7

How do you manage a corneal abrasion?

Answer 7

1) Evaluate with a fluorescein lamp
2) Irrigate any foreign bodies out
3) Treat infections if present (no need for prophylactic antibiotics in a person with no signs of infection)
4) Don’t patch –research shows it doesn’t change anything

Question 8

Retinal detachment results from what two things?

Answer 8

• Hypertensive crisis

* Trauma (MVC)

Question 9

Those with retinal detachment complain of what symptoms?

Answer 9

Floaters in their visual field

Question 10

A woman complains of a curtain of blackness or floaters that come and goes across her visual field. What is this and how do you treat it?

Answer 10

Amaurosis fugax (occlusion of the retinal artery)

It is an “eye stroke,” so you give tPA in the absence of contraindications.

Question 11

Amaurosis fugax can be differentiated from occipital stroke by _______________.

Answer 11

the absence of other neurologic problems

Question 12

Those with amaurosis fugax have what ophthalmologic exam finding?

Answer 12

Cheery-red spot on the fovea

Question 13

The history of cataracts is notable for ____________.

Answer 13

progressive loss of nighttime vision

Question 14

Differentiate the two types of macular degeneration.

Answer 14

Both result in a chronic degeneration of the central retina.

• Wet: neoangiogenesis, presents with fluid and blood vessels on fundoscopic exam, treatable with laser ablation of blood vessels
• Dry: pigment changes on retina, no treatment