Ophth Flashcards by brandon lovin

What are the components of the basic eye exam?

C ROAD MAP
Confrontation
Reaction
Ophthalmoscopy
Acuity
Depth
Motility
Ancillary- Amsler Color Eversion
Pressure

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Eyelids are called ?

What are their two functions

Palpebrae

Protection
Spread new/drain old tears

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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

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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

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Eyes work in ?, “ ? “

What type of response has to happen for movement to occur?

Tandem, yoked

Ipsilateral opposing relaxation

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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

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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

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Define Strabismus

Define Phoria

Define Tropia

Misalignment of eye

Misalignment evident w/ eye covered

Misalignment w/ eyes open and uncovered

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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

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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

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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

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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

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Congenital ocular misalignment puts PT at risk for ?

Define ‘Third Strabismus’ and the cause

Amblyopia

R eye- normal
L eye- down/left
Aneurysm

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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

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Define Nystagmus

Most of these are congenital cases due to ? and require ?

Repetitive rhythmic oscillations of the eye

Idiopathic, no eye exam required

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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

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How are amblyopias Tx

Tx methods are best before ? age due to ?

Glasses
Patch/Atropine of better eye
Surgery

<8y/o, neuroplascticity

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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

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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

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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

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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

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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

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Define Hordeolum

How does it present

How is it Tx

Staph infected/sebaceous gland nodule

Painful

Compress/massage
Doxy/Erythromycin
Resistant- surgical drainage

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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

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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

What antihistamines/cell stabilizers can be used for alelrgic conjunctivitis What can be used for severe cases? What PO antihistamines can be used?

Olopatadine Ketotifen Loteprednol Cetirizine Fexofenadine Diphenhydramine

# Define Pinguecula How does it present How is it Tx

Bumpy “growth” on the exposed conjunctiva at 3/9 o’clock region ASx w/ no vision loss Tears/steroid

# Define Pterygium How does it present How is it Tx

Bumpy “growth” on the exposed conjunctiva at 3/9 o’clock region Invasive growth into cornea affects vision Surgical removal

# Define Thyroid Eye Dz This condition is the MC cause of ?

Graves Ophthalmopathy, but can be any thyroid state Bi/unilateral proptosis in adults

How are Thyroid Eye Dz cases worked up? How is it Tx

Complete thyroid test Normal- careful monitoring CT confirms opthalmic Dx Mild- tears, elevate, tape Mod/Sec- Prednisone Surgical interventions

What is used to stain corneal abrasions? If penetrating trauma is present, what will be seen? How are these Tx?

Sodium fluorescein Seidels sign Topical ABX Cycloplegic Do not patch

# Define Bacterial Keratitis This MC occurs in ? population but can be seen in ?

Bacteria infection of cornea affecting the stroma Contact lens wearers Anterior segment dz

How is bacterial keratitis Tx If PT wears contacts, what ABX are added?

Daily f/u w/: Fluoroquinolones and Cycloplegic drops Polymyxin B/Trimeth Trobramycin

What population is at high risk for pseudomonas keratitis?

Contact wearers Perf <48hrs

How does fungal keratitis present How does this type of infection begin? What needs to be avoided during Tx

Asymmetric w/ feathery edge Traumatic vegetative matter Topical steroids

? military population is at high risk for fungal keratitis What are the two functions of the sclera

Recent ocular surgery Topical CCS Protection Attachment points for EOMs

What materials make the sclera Where is the sclera thickest

Collagen Elastic fibers Posterior aspect

Episclera is joined to ? structure What is the function of this structure

Tenon's capsule CT around globe Covers tendons at EOM insertions

How does Episcleritis present How is it Tx

More common younger adult w/ red/dull pain Sectorial, engorged vessels No d/c Midl: cold compress, tears Mod/Sev:Fluorometholone Loteprenol NSAID

What are the two causes of scleritis? How does it present What PE test confirms Dx

Idiopathic of systemic CT Dz Severe boring pain* Phenylephrine doesn't show blanching (test in episcleritis will blanch)

How is scleritis Tx What meds are added if case is resistant to Tx?

NSAIDs H2 blocker- Rantidine Prednisone, Clophosphamide

What are the 3 parts of the uveal tract What are the S/Sxs of Anterior Uveitis

Iris- only visible part Ciliary body Choroid Conjunctival ciliary injection/flush Keratic precipitates: Fine/white= non-granulous Mutton fat= granulous

What are the associated d/s w/ Anterior Uveritis Labs are needed if this condition has ? presentation/

``` Reiter/Ankylosing HLA-B27 JA Infection (Syph/TB) Lymphoma Sarcoidosis ``` Bilateral Granulomatous Recurrent

How is Anterior Uveitis Tx What is the PTs prognosis?

Referral Atropine/Scopalamine Prednisolone First time non-granule: good Recurrent granule: poor

What is the MC cause of Posterior Uveitis What other etiologies can cause it?

Toxoplasmosis ``` CMV Autoimmune Syph/TB/Toxocarisis Idiopathic Malignant ```

How does posterior uveitis present on PE? How is it Tx

Inflammatory cells in vitreous- hazy exam Disc swelling w/ edema Retinal/choroid hemorrhage- exudate/infiltrates Refer Cycloplegic/steroid if anterior involved

What is the MC severe infection affecting the eye? This MC usually isn't seen until ? lab result is present?

CMV Retinitis CD4 <100

What is the MC finding on exam of CMV retinitis How quickly can PT go blind

Cotton-wool spots 2-6mon

Visual chart of eye muscles used for looking in different locations

PT R: SR IO LR MR IR SO PT L: IO SR MR LR SO IR

What is the MC Sx of late onset strabismus cause by trauma, stroke or tumor What part of the body has the highest concentration of protein than any other tissue

Diplopia Lens

What are the 3 layers of the lens What is the biggest RF for cataracts? What is a common and other presenting complaints?

Capsule Cortex Nucleus Age Glare w/ headlights- Common Monocular diplopia Dec color perception

What is a benefit of developing nuclear cataracts? What is the opposite of this benefit?

Second sight- thickening of lens improves near vision Near vision dec w/ posterior subcapuslar

How are cataracts Tx What are the reasons to perform surgery on cataracts?

Early- spactacles Small central- dilation Large- surgery/corrective refractive Prevention of deprivational amblyopia in infants Improve visual function Management of ocular dz (Glaucoma Diabetic retinopathy)

MC cause of congenital cataracts When do these become medical emergencies

Idiopathic Congenital cataracts in infant- surgery w/in first 3-4mon to prevent permanent amblyopis

What is the difference berween subluxation and dislocation of lens? What is the MC cause of subluxation lens anomalys?

Sub: decentered Dis: displaced Trauma

What are the S/Sxs of a lens position anomaly? If PT w/ Marfans has lens position anaomaly, where is it usually displaced to? If PT has homocystinuria, where is the lens usually displaced?

``` Iridodonesis Phacodonesis Angle closure glaucoma Irregular astigmatism Dec vision w/ monocular diplopia ``` Superotemporal Inferonasal

# Define Floaters Define flashes

Small aggregates of vitreous from normal aging process Vitreal traction on peripheral retina

What would be seen if PT presents w/ flashes and migraines? If PT presents w/ flashes and floaters, ? is suspected

Scintillations Zig-zag lights Blood/pigment in vitreous

S/Sxs of vitreous detachment How are these Tx

Sudden appearance of black spots/flashing lights Floaters Photocoagulation Cryotherapy Refer

What vessel supplies the inner and outer retina? What is a normal vascular branching pattern? How do arteries and vessels appear different?

In: central retinal artery Out: choroid 2:3 A:V ratio Art: thin, orange/red Vess: larger, crimson

S/Sxs of retinal artery occlusion What will be seen on PE? What vascular structure will be spared?

Painless unilateral acute vision loss Cherry red macula Box car segmentation of arterioles Cilioretinal

Why is the macula spared during retinal artery occlusions If PT has BRAO, what type of vision loss will they present w/?

Choidal supply Horizontal hemifield vision loss

What is the first set of orders placed for suspected retinal artery occlusion? What controversial Txs may be done?

ESR CRP Platelets Timilol Acetazolamide Massage Paracentesis, anterior

How do retinal vein occlusions present What could be seen on PE? What type of vision loss do they present w/?

Unilateral painless loss of visoin w/ possible RAPD Blood and Thunder fundus Flame shaped hemorrhage Horizontal hemifield loss w/ respect to horizontal line

How are retinal vein occlusion Tx What is the leading cause of blindness in the US for PTs between 20-64?

D/c OCPs Ophth eval <72hrs ASA Diabets

After Dx of DM, how long do PTs have to have visual baseline established? What type of DM rarely has retinopathy

<6mon Type 1, but most will develop w/in 30yrs

What is seen at the different levels of severity in non-proliferative diabetic retinopathy

``` VMild- microaneurysms Mild- CW spots Exudates Microaneurysms Mod: retinal hemorrhages, mild IRMA Sev: 4-2-1 rule 4 quadrants of severe retinal hemorrhage 2 or more quadrants of venous beading 1 quadrant or more of moderate IMRA ```

What is the hallmark finding of proliferative diabetic retinopathy Where does the MC tend to be found

Neovascularization Mascular arcades

What will be seen on PE of proliferative diabetic retinoapthy How is this form of retinopathy Tx

Pre-retinal hemorrhage (board shaped) CW spots Loss of red reflex w/ floaters PRP Anti-VEGF injection Tight glycemic control

What is the criteris for clinically significant macular edema

Edema <500um (1/3 disc diameter) to center of fovea Hard exudate <500um from center of fovea Retinal edema >1disc area/diameter of focea

What causes retinitis pigmentosa How do these PTs present What is seen on PE?

Loss of photoreceptors Changes in retinal pigmentation Night blindness Bone spicule pigmentary retinopathy

How is retinitis pigmentosa managed? What are the 3 different types of retinal detachments?

Vit ADEK supplements Rhegmatogenous- break/tear Exudative- leak w/out break (mass) Traction- proliferative diabetic retinopathy

How does a retinal detachment present? If VA is significantly affected what may be seen?

Flashers and Floaters Curtain pulled down Metamorphopsia Ripples in a pond0 retinal hydration lines RAPD

How can a retinal detachment be identified on PE? How are these Tx

Eye w/ detachment= lighter reflex Bed rest w/ head back Refer, surgery