Ophth Flashcards
What are the components of the basic eye exam?
C ROAD MAP Confrontation Reaction Ophthalmoscopy Acuity Depth Motility Ancillary- Amsler Color Eversion Pressure
Eyelids are called ?
What are their two functions
Palpebrae
Protection
Spread new/drain old tears
What are the three muscles of the eyelid, their function and nerve innervation/
Orbicularis oculi- closes, CN7
Levator palpebrae- opens, CN3
Muellers- opens both, S-ANS
What movements to the rectus and oblique muscles of the eye do?
SR: elevate
LR: abduct
IR: depress
MR: adduct
IS: intor/depress
SO: extro/elevate
Eyes work in ?, “ ? “
What type of response has to happen for movement to occur?
Tandem, yoked
Ipsilateral opposing relaxation
Define Emmetropia
Define Hyperopia
Define Myopia
Normal, clearly seen w/ unaccommodated eyes
Farsighted, short axial length causes images to fall behind
Near sighted, long axial length causes images to fall in front
Define Astigmatism
Define Presbyopia
Eliptical shape, different refracting power between cornea/lens (difference on horizontal/vertical axis)
Loss of accommodation; progressive hardening of lens and loss of ability to change shape
Define Strabismus
Define Phoria
Define Tropia
Misalignment of eye
Misalignment evident w/ eye covered
Misalignment w/ eyes open and uncovered
What are the three types of eye deviations
Orthophoria- no deviation
Heterophoria- normal deviation, not present on cover-uncover test
Heterotropia- deviation when using both eyes
Noticed on cover-uncover test
What happens during Heterophoria deviation
How is this type of deviation noticed?
Both eyes point in same direction until one eye is covered- fusion broken
When cover applied, covered eye moves away from open eye
Discovered w/ alternating cover test
What happens during a Heterotopia deviation?
What happens if this is congenital?
What type of visual issue occurs due to this deviation?
Both eyes don’t point in same direction when both are open
One eye is suppressed to eliminate diplopia
Deviated eye has amblyopia
How is an ocular misalignment Dx confirmed?
If an acquired cause, what vision issue develops and usually do to ? etiology?
Cover-uncover
Hirschberg
Diplopia (primary/off-axis)
CN palsy/mass
Congenital ocular misalignment puts PT at risk for ?
Define ‘Third Strabismus’ and the cause
Amblyopia
R eye- normal
L eye- down/left
Aneurysm
Define ‘Fourth Strabismus’ and the cause
Define ‘Sixth Strabismus’ and the cause
Both eyes to R
Congenital trauma
R eye normal
L eye- right deviation
Cranial pressure
Define Nystagmus
Most of these are congenital cases due to ? and require ?
Repetitive rhythmic oscillations of the eye
Idiopathic, no eye exam required
Define Neuro-significant Nystagmus
Define Amblyopia
These are AKA ?
Vertical/see-saw movements from brain stem lesion
Abnormal development of visual system w/out anatomical damage
Lazy eyes
How are amblyopias Tx
Tx methods are best before ? age due to ?
Glasses
Patch/Atropine of better eye
Surgery
<8y/o, neuroplascticity
What are the three layers of tears and where are they made?
What are the three parts of the drainage system?
Outer- oil, meibomian
Middle- water, accessory
Inner- mucin, goblet
Punctum
Canaliculus
Sac
Duct
Define Ectropion
What causes this and how does it present
How is it Tx
Outward turning of lower lid
Inc lid laxity
Tearing, Irritation
Lubrication until surgery
Define Entropion
What causes this and how does it present?
How is it Tx?
Inward turning of eyelid
Involutional- age
Tearing Irritation
Lubricate until surgery
Define Blepharitis
How does it present
How is it Tx?
Inflammation of eyelid
Epiphoria worse in morning
Burning Foreign sensation
Shampoo/Compress
Staph etiology- Erythromycin ointment
Meibomian dysfunction- Doxy/Erythromycin
Define Chalazion
How does it present
How is it Tx
Inflammation due to blocked meibomian gland
Mild discomfort, well demarcated
Warm compress/massage
>4wks- Triamcinolone or escision
Define Hordeolum
How does it present
How is it Tx
Staph infected/sebaceous gland nodule
Painful
Compress/massage
Doxy/Erythromycin
Resistant- surgical drainage
Hordeolums are AKA ?
What Tx combo is used for hordeolums if blepharitis is also present?
When are these referred to surgery?
Styes
Erythromycin and Doxy
> 4wks ABX failure
When are Triamcinolone injections for chalazions c/i?
Define Dacryoadenitis
How does it present
Dark complexion PTs
Inflammation of lacrimal gland
Acute temporal lid tenderness
How is Dacryoadenitis Dx confirmed
If condition is bilateral, consider ? systemic Dzs
if infectious etiology, consider ?
Orbital CT
Sarcoid/Sjogrens
Mumps Mono
How is Dacryoadenitis Tx
Define Dacryocystitis
Mild- cold compress, NSAIDs
Acute/Purulent- systemic ABX
Infection- Augment/Cephalexin
Inflammation of lacrimal sac/canaliculus from bacterial infection/duct obstruction
How is Dacrycystitis Tx
Define the conjuctiva and the two types and where they meet
Augmentin/InD
Febrile PTs- admit, IV ABX
Thin membrane on eyelid/eye
Palpebra: inner eye lid
Bulbar: sclera
Both meet at fornix
MC cause of viral conjunctivitis
How does it present
How is it Tx
Adenovirus
Preauricular adenopathy
Self limiting
Highly contagious Week 2
ABX only if secondary bacterial infection present
What causes allergic conjunctivitis
How does it present
How is it Tx
Pollen Mold Pets
Severe itching
Stringy d/c
Topical antihistamines
What causes bacterial conjunctivitis
How does it present
How is it Tx
Staph A
Strep pneumo
C trachomatis
N ghonorrea
Thick d/c
Non-gonoccocal:
Tirmeth/Polymyxin B
Besi/Moxifloxacin
Neisseria/Chlaymida:
Ceftriaxone (Cipro if PCN c/i)
Topical fluroquinolones- if cornea involved
Azith or Doxy
What 3 DDx microbes must be considered when Dxing bacterial conjucntivitis
Why do these need to be considered?
N gonorrhoeae/meningitidis
C trachomatis
Gonoccocal infections can cause corneal ulcer and perf quickly
