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ICM Unit 3 HEENT > Ophthalmic Disorders > Flashcards

Ophthalmic Disorders Flashcards

1
Q

COMMON EYE COMPLAINTS

A

Redness
Pain
Foreign body sensation
Photophobia
Dryness
Watery eyes
Decreased visual acuity
Loss of vision
Double vision
Conjunctival discharge
“Spots,” “floaters,” “flashing lights”

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2
Q

Eye redness diseases

A

Acute conjunctivitis
Acute Anterior Uveitis (iritis)
Acute Angle-Closure Glaucoma
Corneal Trauma or Infection

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3
Q

what can cause ocular discomfort?

A

Pain (trauma, infxn, rapid increase in IOP)

Dry eye (lacrimal gland hypofunc. related to systemic disorders or drugs)

Watery eyes (inadequate tear drainage related to obstruction of lacrimal drainage sys or malposition of lower lid, reflex tearing due to disturbance of corneal epithelium)

Photophobia (keratitis, iritis, albinism, aniridia, cone dystrophy, fever due to systemic infection)

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4
Q

Strabismus

A

Ocular misalignment

Only one eye fixates on an object

Present in ~4% of children
“Ocular instability of infancy” - unsteady ocular alignment often present in normal newborns during first few months of life, typically goes away after 4-6 months

Risk factors = family history, preterm/low birth weight, other ocular conditions, certain neuromuscular conditions

Can also be acquired due to cranial nerve palsies or orbital mass, fracture, or thyroid eye disease

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5
Q

Prefix describes

A

direction of eye deviation

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6
Q

Eso

A

inward

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7
Q

Exo

A

outward

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8
Q

Hyper

A

upward

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9
Q

Hypo

A

downward

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10
Q

Suffix describes

A

conditions under which it is present

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11
Q

Phoria (latent strabismus)

A

strabismus that is present only when binocular fusion is disrupted (i.e. when one is covered)

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12
Q

Tropia (manifest strabismus)

A

strabismus that is present when there is no disruption of binocular fusion

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13
Q

Most common causes - Strabismus
Esodeviations =

A

DASIA

accommodative esotropia, idiopathic infantile esotropia, Duane syndrome, abducens palsy, sensory esotropia

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14
Q

Most common causes - Strabismus
Exodeviations =

A

intermittent exotropia

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15
Q

Most common causes - Strabismus
Hyperdeviations =

A

trochlear nerve palsy

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16
Q

Most common causes - Strabismus
Hypodeviations =

A

fracture of orbital floor or wall, thyroid-related ophthalmopathy, Brown syndrome, oculomotor palsy, trochlear nerve palsy, congenital fibrosis of extraocular muscles

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17
Q

Strabismus test

A

Corneal light reflex (Hirschberg test)

Cover test (detects tropia) - looking at uncovered eye

cover/uncover test (detects phoria)

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18
Q

cover test

A

Detects tropia (manifest strabismus)

In this test, the child is asked to visually fixate on a target at distance or near. The examiner briefly covers one eye while observing the opposite eye for movement

No movement is detected when covering either eye if the child has normal ocular alignment (orthotropia).

Manifest strabismus (tropia) is present if the eye that is not occluded with the cover test shifts to refixate on the target when the fellow previously fixating eye is covered

repeat on each eye

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19
Q

Cover/uncover test

A

Detects phoria (latent strabismus)

Do not have to do if cover test reveals tropia

the child is asked to visually fixate on a target at distance or near. A cover is placed over one eye for a few seconds, and then it is rapidly removed. The eye that was under the cover is observed for refixation movement

If a phoria is present, this previously covered eye will shift back into the orthotropic (straight-ahead) position to reestablish sensory fusion with the other eye

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20
Q

Strabismus complications

A

amblyopia (in up to half of younger children with strabismus)

Diplopia (in acquired strabismus in patients > 8 years old

Secondary contracture of extraocular muscles

Adverse psychosocial and vocational consequences

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21
Q

when to refer (strabismus)

A

Constant strabismus at any age

Intermittent manifest strabismus after 4-6 months of age

Persistent esodeviations after 4 months of age

Abnormal corneal light reflex test or cover test

Deviation that changes depending on position of gaze

Diplopia or asthenopia

Parental concern about ocular alignment

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22
Q

Corneal light reflex (Hirschberg test)

A

shining a light onto the child’s eyes from a distance and observing the reflection of the light on the cornea with respect to the pupil. The location of the reflection from both eyes should appear symmetric and generally slightly nasal to the center of the pupil

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23
Q

Treatment (strabismus)

A

Non-surgical = glasses, contacts, occlusion therapy, visual training exercises

Surgical = recession, resection and transposition of extraocular muscles

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24
Q

Amblyopia - what it is

A

Functional reduction in visual acuity caused by abnormal visual development early in life

50% of cases related to strabismus

predominately unilateral (defined as as ≥ 2 line difference in visual acuity between eyes)

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25
Q

Amblyopia risk factors

A

prematurity,

small for gestational age,

first-degree relative with amblyopia,

neurodevelopmental delay

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26
Q

Amblyopia MCC of

A

ped visual impairment (1-4% children)

One of the reasons we assess vision in preschool-age children!
Vision screening at age 3, 4, and 5

Refer to ophthalmology/optometry if suspected

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27
Q

Leukocoria

A

White pupillary reflex

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28
Q

Leukocoria common causes

A

Retinoblastoma!

Cataract, coats dz, persistent fetal vasculature, vitreous hemorrhage, ocular toxocariasis, Hereditary retinal dysplasia
Retinal detachment, Coloboma, Astrocytic hamartoma

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29
Q

Retinoblastoma

A

Most common primary intraocular malignancy of childhood

accounts for 10-15% cancers that occur w/i first year of life

median age at dx = 18-20 months

typically presents at leukocoria in a child <3 years

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30
Q

Retinoblastoma other S/S

A

Strabismus!

Nystagmus; red, inflamed eye; decreased vision; FH

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31
Q

Retinoblastoma Treatment

A

deadly if untreated, tx is very successful (>95% 5-year survival rate)

multidisciplinary approach
- chemo
- surgery
- cryotherapy
- laser photoablation

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32
Q

Retinitis Pigmentosa

A

Causes progressive loss of night and peripheral vision

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33
Q

Retinitis Pigmentosa

A

group of inherited dystrophies = progressive degeneration and dysfunction of retina

Primarily affects photoreceptor and retinal pigment epithelial function

May occur alone or as part of a syndrome

May be inherited or occur sporadically

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34
Q

Retinitis Pigmentosa - Ophtho findings

A

Attenuation of retinal blood vessels

Waxy pallor of optic disc

Intraretinal pigmentation in a bone-spicule pattern

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35
Q

Retinitis Pigmentosa - Treatment

A

no great tx currently

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36
Q

Conjunctivitis

A

Inflammation of the mucous membrane that lines the surface of the eyeball and inner eyelids

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37
Q

Conjunctivitis - 3 types

A

Viral

Bacterial

Allergic

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38
Q

Conjunctivitis - Mode of transmission:

A

direct contact of contaminated fingers or objects to other eye or other persons

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39
Q

Conjunctivitis - symptoms

A

foreign body sensation

scratching/burning

itching

photophobia

sensation of fullness around eyes

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40
Q

Viral conjunctivitis

A

MCC = adenovrius

May or may not be part of viral prodrome followed by adenopathy, fever, pharyngitis, URI

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41
Q

Viral conjunctivitis usually sequential

A

bilateral dz

spreads easily

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42
Q

Viral conjunctivitis presentation

A

Conjunctival injection with WATERY or mucoserous discharge

Burning, sandy, gritty feeing in one eye

May have crusting in the morning and scant mucus throughout the day

May see small amount of mucoid discharge when pulling down lower lid on exam, but usually profuse tearing

+/- follicular appearance of tarsal conjunctiva

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43
Q

Viral conjunctivitis management

A

no specific tx

lasts up to 2 weeks; may get worse before better (consult pts on this)

Artificial tears and cold compresses may help discomfort

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44
Q

Viral conjunctivitis made up story

A

Adens kid FOLLed 2 weeks ago at the Sandy shore. His kids EYES (both eyes watery) filled with water because it he just had a viral infection. I told that kid it may get worse before it gets better. It was COLD that day anyway.

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45
Q

Bacterial Conjunctivitis MC organisms

A

Staph aureus, Strep pneumo, Haemphilus species, Pseudomonas (contact lens wearers), Moraxella

“Some Say Hairy People that wear contacts Make bacterial conjunctivitis)”

other causes gonococcal conjunc. and chlamydial conjun.

“they have gonorrhea and chlaymdia and are very contagious”

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46
Q

Bacterial Conjunctivitis other factors

A

usually unilateral

highly contagious

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47
Q

Bacterial Conjunctivitis clinical presentation

A

Purulent eye discharge
Eyelid matting
Mild discomfort
Mild blurring of vision

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48
Q

Bacterial Conjunctivitis - management

A

Usually self-limited
Lasts 10-14 days if untreated
Topical antibiotics may hasten remission
May consider depending on back-to-school considerations

Erthryo ointment or Bactrim (TMX-SMP) drops

Contact lens wearers must always be treated!
(fluoroquinolones drop such as ofloxacin or ciprofloxacin)

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49
Q

Made up story Bact. Conjunc.

A

Some Say Hairy People that wear contact lens Make bacterial conjunctivitis in one eye. They have Gonorrhea and Chlamydia so they are very Contagious. They discharge constantly and pray on a Mat that is goes away. Luckily is doesn’t hurt too bad and they just have mild blurry vision, this should be a Self lesson. Maybe a 2 week lesson. I they are in school they can have antibiotic topicals because we don’t want them to come BACk with red eyes (erythromycin) and if they do wear contact lens they should be treated with eye drops Of Course (ofloxacin and ciprofloxacin). She needs new makeup anyway and forget about them contacts until the discharge is gone for another 24.

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50
Q

Contact users for Bact. Conjunc.

A

ciprofloxacin vs ofloxacin

Don’t wear contacts until no longer red and no discharge 24 hours after taking meds; change makeup esp. things like eyeliner

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51
Q

Gonococcal Conjunctivitis

A

usually acquires thru genital secretions

ophthalmic emergency!

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52
Q

Gonococcal Conjunctivitis - clinical presentation

A

Copious purulent discharge

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53
Q

Gonococcal Conjunctivitis - Diagnosis

A

confirm with stained smear and culture of discharge

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54
Q

Gonococcal Conjunctivitis - Management

A

Single dose ceftriaxone IM

May add topical erythro/bacitracin

Also treat for chlamydia (doxy)

Consider other STIs

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55
Q

Chlamydial Conjunctivitis

A

Trachoma = chronic keratoconjunctivitis caused by recurrent infection with Chlamydia trachomatis

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56
Q

Chlamydial Conjunctivitis

MC in

A

children

Typically asymptomatic

May have eye redness, discomfort, light sensitivity, and mucopurulent discharge

Recurrent episodes cause bilateral follicular conjunctivitis, epithelial keratitis, corneal vascularization, scarring of tarsal conjunctiva

Scarring of tarsal conjunctiva leads to entropion and trichiasis

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57
Q

Chlamydial Conjunctivitis -
Adult inclusion conjunctivitis

A

Chronic, indolent conjunctivitis caused by certain serotypes of C. trachomatis

Concurrent asymptomatic urogenital infection typically present

Usually unilateral follicular conjunctivitis lasting weeks-months that has not responded to topical antibiotics

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58
Q

Chlamydial Conjunctivitis - Diagnosis

A

Giemsa or DFA stain of conjunctival smears or culture of swabbed specimen

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59
Q

Chlamydial Conjunctivitis - Treatment

A

Single dose of azithromycin PO

surgery to correct lid deformities

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60
Q

Allergic Conjunctivitis

A

Usually associated with atopy:
Eczema, asthma, allergic rhinitis

May be seasonal (hay fever); usually in spring/summer

Bilateral

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61
Q

Allergic Conjunctivitis - Clinical Presentation

A

Itching

Conjunctival hyperemia and edema (chemosis)

Watery discharge

Cobblestoning of upper tarsal conjunctiva
Itching

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62
Q

Allergic Conjunctivitis - Management

A

Avoid known allergens
Avoid rubbing
Cool compresses
Artificial tears
Avoid contact lenses
Topical therapy (see next slide)
Oral H1 antihistamines

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63
Q

Examples of antihistamines for Allergic Conjunc.

A

Olopatadine (OTC) - usually 1st line + oral antihistamine

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64
Q

Vasoconstrictor/antihistamine combo (allergic conjunc)

A

Usually not recommended b/c after using can make eyes red

Naphazoline and pheniramine (OTC)

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65
Q

Mast cell stabilizers (allergic conjunc)

A

can be used if initial antihistamine not effective enough

Rx only

Cromolyn sodium
Nedocromil

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66
Q

Big Picture - Bacterial Conjunc.

A

unilateral or bilateral

Discharge most prominent symptom
Eye often “stuck shut” in morning

No other symptoms

“red eye”

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67
Q

Big Picture - Viral Conjunc.

A

Unilateral or bilateral

Sensation of grittiness, burning, or irritation
Crusting on lid margin in morning

May be part of viral URI w/ associated nasal congestion or pharyngitis

“red eye”

68
Q

Big Picture - Allergic Conjunc.

A

Typically bilateral

Itching
Sensation of grittiness, burning, or irritation
Crusting on lid margin in morning

May have other allergic symptoms, such as nasal congestion, sneezing, cough, wheezing

“red eye”

69
Q

Bacterial Conjuctivits - Tx

A

self limited

topical abx may shorten symptom duration and required for contact lens wearers

70
Q

Viral Conjunctivitis - Tx

A

Self limited

topical antihistamines and/or topical decongestants

warm or cool compresses

71
Q

Allergic Conjunctivits - Tx

A

minimizing exposure to allergen

topical lubricants

cool compresses

topical or systemic antihistamines

72
Q

Dacryocystitis

A

Infection of lacrimal sac secondary to obstruction of nasolacrimal duct

Thought to be related to chronic inflammation resulting in fibrosis within the duct

uncommon

73
Q

Dacryocystitis Pathogens

A

S aureus, S epidermis, Pseudomonas aeruginosa or anaerobic organisms

74
Q

Dacryocystitis - Clinical Presentation

A

Tearing/discharge

Inflammation, pain, swelling, tenderness beneath medial canthal tendon in area of lacrimal sac

May be able to express purulent drainage through lacrimal puncta by applying pressure to sac

75
Q

Dacryocystitis - Diagnosis

A

Gram stain/culture of drainage

76
Q

Dacryocystitis - Treatment

A

Antibiotics based on gram stain/culture results

Surgical correction

77
Q

Keratoconjunctivitis Sicca

A

AKA Dry eye disease

Multifactorial

loss of hemostasis of tear film

Can have significant impact on visual acuity, social/physical functioning, and workplace productivity

78
Q

Keratoconjunctivitis Sicca- Risk factors

A

Advanced age
Female sex
Hormonal changes
Systemic diseases (DM, Parkinson’s, Sjogren’s)
Contact lens wear
Systemic/ocular medications
Nutritional deficiencies (vitamin A)
Decreased corneal sensation
Ophthalmic surgery
Low-humidity environments

79
Q

Keratoconjunctivitis Sicca - Management

A

Artificial tears
Discontinue offending medications if possible
Warm compresses

80
Q

Made up story - KCS

A

Keep Congress Stupid - they cant see what’s going on , no social life, and especially no workplace productivity. They are just so DRY. Most are old, some women with hormone changes (yikes), some had eye surgery and have to wear contacts and take medication for. They just need to have WARMer hearts or DISCONTINUE working. Cry me a river (of artificial tears)

81
Q

HSV Keratitis

A

Ability of virus to colonize trigeminal ganglion leads to recurrences that may be precipitated by fever, excessive exposure to sunlight or immunodeficiency

Typically unilateral

82
Q

HSV Keratitis - Clinical Presentation

A

Dendritic (branching) corneal ulcer!!!

Lid, conjunctival or corneal ulceration

83
Q

HSV Keratitis - Diagnosis

A

Fluorescein stain and examination with cobalt blue light

84
Q

HSV Keratitis - Treatment

A

Topical or oral antivirals
- Trifluridine drops, ganciclovir gel, acyclovir ointment (10-14 days)
- Acyclovir, valacyclovir PO

Avoid topical corticosteriods (leave to ophtho) - CS can promote viral replication

85
Q

Bacterial Keratitis MC pathogens

A

staph, strep, Pseudomonas aeruginosa, Moraxella species, other gram neg bacilli

86
Q

Bacterial Keratitis - risk factors

A

Contact lens wear (especially overnight)
Corneal trauma

87
Q

Bacterial Keratitis - Clinical presentation

A

Foreign body sensation
Difficulty keeping eye open!!
Central corneal ulcer
+/- hypopyon (WBC in anterior chamber and fall to bottom = emergency!)
Mucopurulent discharge

88
Q

Bacterial Keratitis - Treatment

A

Urgent ophtho referral
Topical fluoroquinolones applied hourly for first 48 hours

89
Q

Herpes Zoster Ophthalmicus

A

freq involves ophthalmic division of trigeminal nerve

Involvement of tip of nose or lid margin predicts involvement of the eye

Potentially sight-threatening

90
Q

Herpes Zoster Ophthalmicus - Clinical Presentation

A

Periorbital burning/itching
Vesicular rash that becomes pustular, then crusts
Conjunctivitis, keratitis, episcleritis, anterior uveitis
+/- elevated IOP

91
Q

Herpes Zoster Ophthalmicus - Tx

A

Urgent ophtho referral

High dose oral antivirals
(Acyclovir, valacyclovir, famciclovir x 7-10 days)

92
Q

Periorbital Cellulitis

A

AKA preseptal cellulitis

Infection of soft tissues anterior to orbital septum
Does not involve orbit or other ocular structures
May be confused with orbital cellulitis
Generally mild, rarely leads to serious complications
May arise from sinusitis or local trauma

93
Q

Periorbital Cellulitis - Pathogens

A

If related to sinuses or nasopharynx = S pneumo, Moraxella, H influenzae

If arising from trauma or other skin infection = Staph aureus, Strep pyogenes

94
Q

Periorbital Cellulitis - Clinical Presentation

A

Unilateral ocular pain
Eyelid swelling and erythema

Does NOT affect visual acuity or extraocular movements

95
Q

Periorbital Cellulitis - Treatment

A

Empiric abx
Amoxicillin/clavulanate

Consider admission in children < 1 year old, severely ill, or unsure if orbit is involved

96
Q

Orbital Cellulitis

A

Infection involving contents of orbit (fat and extraocular muscles)

Can be vision/life-threatening

MC in children

Typically caused by infection of paranasal sinuses

97
Q

Orbital Cellulitis - Clinical presentation

A

Fever
Proptosis

Restriction of extraocular movements

Pain/swelling with redness of lids
Decreased visual acuity

98
Q

Orbital Cellulitis - Diagnosis

A

CT/MRI
Culture if purulent drainage on exam

99
Q

Orbital Cellulitis - Treatment

A

Urgent IV abx to prevent optic nerve damage and spread of infection

Antibiotic choice depends upon pathogen
Empiric = vancomycin + ceftriaxone

+/- surgical drainage of paranasal sinuses/orbital abscess

100
Q

Orbital Cellulitis - Complications

A

Cavernous sinus thrombosis
Intracranial extension
Vision loss
Death

101
Q

Big picture - Preseptal Cellulitis

A

Eyelid swelling w/ or w/o erythema

Eye pain/tenderness may be present

chemosis rarely present

Fever and leukocytosis may be present

102
Q

Big Picture - Orbital Cellulitis

A

Eyelid swelling w/ or w/o erythema

Eye pain/tenderness

Pain w/ eye movements

Proptosis usually but may be subtle

Ophthalmoplegia +/- diplopia may be present

vision impairment may be present

Chemosis and leukocytosis may be present

Fever usually present

103
Q

Blepharitis

A

Chronic bilateral inflammatory condition of lid margins
- Anterior = involves lid skin, eyelashes and associated glands
- Posterior = results from inflammation of meibomian glands

Common cause of recurrent conjunctivitis

104
Q

Blepharitis - Clin Pres

A

Irritation, burning, itching

Anterior = “red-rimmed” eyes with scales clinging to lashes

Posterior = hyperemic lid margins with telangiectasias, inflamed meibomian glands

105
Q

Blepharitis - Tx

A

Anterior = warm compresses, eyelid cleansing with baby shampoo, antibiotic ointment for acute exacerbations

Posterior = Regular meibomian gland expression, warm compresses

106
Q

Chalazion

A

Common granulomatous inflammation of a meibomian gland that may follow an internal hordeolum

107
Q

Chalazion - Clin Pres

A

Hard, NONTENDER swelling on upper or lower lid

Redness and swelling of adjacent conjunctiva

108
Q

Chalazion - TX

A

Warm compresses
Incision and curettage if not resolved in 2-3 weeks
Corticosteroid injection may be effective

Typically improve over several months- refer to ophtho for IL corticosteriod injection or surgical removal

109
Q

Hordeolum (stye)

A

Acute infection/abscess of either meibomian gland (internal) or gland of Zeis or Moll (external)

MC due to staph aureus

110
Q

Hordeolum - Clin Presentation

A

Localized red, swollen, TENDER area of upper or lower lid

111
Q

Hordeolum - Tx

A

Warm compressions

Incision if not resolved in 48 hours

Topical antibiotic ointment applied every 3 hours during acute stage

Generally improves w/i 1-2 weeks

112
Q

Hordeolum - complications

A

Internal hordeolum may lead to generalized cellulitis of lid

113
Q

Chalazion - risk factors

A

Rosacea, posterior blepharitis

114
Q

Hordeolum - risk factors

A

Rosacea, seborrhiec dermatitis, use of eye make-up

115
Q

Cataracts

A

Opacities of crystalline lens
Usually bilateral
Leading cause of blindness worldwide
MCC = age

116
Q

Cataracts - other causes

A

Congenital
Traumatic
Systemic disease (DM)
Topical, systemic, or inhaled corticosteroid treatment
Uveitis
Radiation exposure

117
Q

Cataracts - risk factor

A

smoking cigarettes

118
Q

Cataracts - clinical presentation

A

Progressive blurring of vision
Flare in bright lights or night driving

119
Q

Cataracts - Tx

A

Surgery (improves visual acuity in 95% of cases)

Topical eye drops to dissolve or prevent cataracts are being experimented

120
Q

Cataracts - Prevention

A

Multivitamin/mineral supplement

High dietary antioxidants

121
Q

Chronic Glaucoma

A

Gradually progressive excavation (“cupping”) of optic disk with progressive loss of vision (slight visual field loss to complete blindness)

122
Q

3 types of Chronic glaucoma

A

Open- angle (Elevated IOP due to reduced drainage of aqueous fluid through trabecular meshwork)

Angle-closure (Obstruction of flow of aqueous fluid into anterior chamber)

Normal-tension (Normal IOP but same pattern of optic nerve damage)

123
Q

Chronic Glaucoma

Dx requires consistent and reproducible abnormalities in at least 2/3 parameters:

A

Often first suspected at routine eye test

  • Optic disk cupping = an increase or asymmetry between the two eyes of the ratio of diameter of optic cup to diameter of whole optic disk (ratio > 0.5 or asymmetry > 0.2)
  • Visual field abnormalities (central vision remains good until late in disease)
  • Intraocular pressure = Normal range 10-21 mmHg
124
Q

Chronic Glaucoma - Screening targeted

A

Affected first-degree relative
Diabetes mellitus
Older individuals with African or Hispanic ancestry
Long-term use of corticosteroids

125
Q

Chronic Glaucoma - Tx

A

Prostaglandin analog eye drops
- Latanoprost, bimatoprost

Alpha-2-agonist, topical carbonic anhydrase inhibitors can be used in addition
- Brimonidine, brinzolamide

Laser therapy/surgery
Open-angle glaucoma = trabeculectomy

Angle-closure glaucoma = iridotomy/iridectomy

126
Q

Acute Angle-closure Glaucoma (Primary)

A

Results from a closure of preexisting narrow anterior chamber angle

Closure of angle precipitated by pupillary dilation

127
Q

Acute Angle-closure Glaucoma (Secondary)

A

Does not require preexisting narrow angle

May occur with anterior uveitis, dislocation of lens, hemodialysis, or various drugs

128
Q

Acute Angle-closure Glaucoma - Clin Pres

A

Same symptoms but diff management

Extreme pain
Blurred vision
Halos around lights
+/- nausea, abdominal pain
Red eye, cloudy cornea, moderate dilated pupil that is nonreactive to light
IOP > 50 mm Hg
Hard eye on palpation

129
Q

Acute Angle-closure Glaucoma - Tx

A

Initial treatment is reduction of IOP with IV acetazolamide + topical medications

130
Q

Acute Angle-closure Glaucoma - Tx
Primary

A

Topical 4% pilocarpine q 15 mins x 1 hour, then four times a day

Cataract extraction (definitive; sometimes done first-line)

Laser peripheral iridotomy

Consider prophylactic laser peripheral iridotomy to unaffected eye

131
Q

Acute Angle-closure Glaucoma - Tx
Secondary

A

Treat underlying cause

132
Q

Acute Angle-closure Glaucoma - Prognosis

A

Results in permanent visual loss within 2-5 days if not treated

133
Q

Macular Degeneration

A

Age-related is leading permanent visual loss in older population

Prevalence progressively increases over age 50

Slight female predominance

134
Q

Macular Degeneration - Risk factors

A

Family history
HTN
Hyperlipidemia
CVD
Farsightedness
Light iris color
Cigarette smoking

135
Q

Macular Degeneration - 2 types

A

Wet
Dry

136
Q

Macular Degeneration - Clin Pres

A

Drusen
Hard drusen = discrete yellow subretinal deposits
Soft drusen = paler and less distinct
Central vision loss

“Dry” = gradually progressive bilateral visual loss

“Wet” = more rapid and severe onset of visual loss

137
Q

Macular Degeneration - Tx

A

Dry = no specific treatment

Wet = rehabilitation including low-vision aids; VEGF inhibitors
(Ranibizumab, bevacizumab, aflibercept, brolucizumab)

Stop smoking

Vitamin supplements can reduce progression = vitamins C and E, zinc, copper, carotenoids

138
Q

Retinal Detachment 3 types

A

Rhegmatogenous (most common)

Tractional

Exudative

139
Q

Retinal detachment - Rhegmatogenous

A

One or more peripheral retinal tears or holes

Usually results from posterior vitreous detachment related to degenerative changes in vitreous

Can also be caused by penetrating or blunt trauma

Often occurs in people > 50 years of age

140
Q

Retinal detachment - Tractional

A

preretinal fibrosis (as in proliferative retinopathy due to diabetic retinopathy or retinal vein occlusion)
OR
complication of rhegmatogenous retinal detachment

141
Q

Retinal detachment - Exudative

A

accumulation of subretinal fluid

, (neovascular age-related macular degeneration or secondary to choroidal tumor

142
Q

Retinal Detachment - Clin Pres

A

Rapidly progressive visual field loss
Floaters
Photopsias

Retina may be seen elevated in vitreous cavity with an irregular surface on ophthalmoscopic exam

143
Q

Retinal Detachment - Tx

A

Laser photocoagulation

Pneumatic retinopexy = (expansile gas injected into vitreous cavity and patient’s head is positioned to facilitate apposition between gas and the hole, which permits reattachment of retina

Vitrectomy, direct manipulation of retina, internal tamponade of retina with air, expansile gas, or silicone oil

144
Q

Corneal Abrasion

A

Defect in epithelial surface of the cornea - mechanical trauma

Can be traumatic (related to foreign body or contact lens) or spontaneous

145
Q

Corneal Abrasion - Clin Pres

A

Severe eye pain
Photophobia

Foreign body sensation preventing opening of eye

146
Q

Corneal Abrasion - Dx

A

Clinical

Can be confirmed on fluorescein stain

Evert eyelid to assess for presence of retained foreign body

147
Q

Corneal Abrasion - Management

A

Removal of foreign body
Topical antibiotics
Cycloplegics for large abrasions (inhibit miotic response to light)
Oral/topical NSAIDs

148
Q

Globe Rupture

A

Occurs following blunt eye injury

149
Q

Globe Rupture - Clin Pres

A

Decreased visual acuity
Relative afferent pupillary defect
Eccentric or teardrop pupil
Increased or decreased anterior chamber depth
Extrusion of vitreous
External prolapse of uvea
Tenting of cornea or sclera at site of injury
Low IOP

150
Q

Globe Rupture - Management

A

Emergent ophtho consult!
Pain control, IV abx
Surgical repair

151
Q

Subconjunctival Hemorrhage

A

May occur spontaneously or with Valsalva associated with coughing, sneezing, straining, or vomiting

Generally asymptomatic

152
Q

Subconjunctival Hemorrhage - Dx

A

confirmed by normal visual acuity and absence of S/S

153
Q

Subconjunctival Hemorrhage - Prognosis

A

Blood generally resorbs over 1-2 weeks (may seem to increase on second day)

No specific treatment

154
Q

Hyphema

A

Blood in the anterior chamber

Common complication of blunt or penetrating eye injury

Can result in permanent vision loss

155
Q

Hyphema- Clin Pres

A

Vision loss
Eye pain
Photophobia
Anisocoria
N/V if elevated IOP
Often accompanied by corneal abrasion

156
Q

Hyphema _ Dx

A

Clinical
Must exclude open globe

157
Q

Hyphema - Management

A

Eye shield
Bed rest/dim lighting
Elevate HOB to 30 degrees
Topical pain control
Close monitoring by ophtho

158
Q

Pterygium

A

Fleshy, triangular encroachment of conjunctiva onto the cornea

Usually associated with prolonged exposure to wind, sun, sand, and dust

Often bilateral

Occurs more frequently on nasal side of the conjunctiva

May become inflamed and may grow

159
Q

Pterygium - Tx

A

rarely required

indicated when growth threatens vision

160
Q

Pinguecula

A

Yellowish, elevated conjunctival nodule in area of palpebral fissure

Common in people > age 35 years

Often bilateral

Occurs more frequently on nasal side of the conjunctiva

Rarely grows but may become inflamed

161
Q

Pinguecula - Tx

A

rarely required
artificial tears beneficial

162
Q

Entropion

A

inward turning of eyelid

163
Q

Entropion Occurs occasionally in

A

older people as result of degeneration of lid fascia

May follow extensive scarring of conjunctiva and tarsus

164
Q

Entropion - Tx

A

surgery if lashes rub cornea;

botulinum toxin injections may help

165
Q

Ectropion

A

outward turning of eyelid

Common with advanced age

166
Q

Ectropion - tx

A

surgery if excessive tearing, exposure keratitis, or cosmetic problem

ICM Unit 3 HEENT (6 decks)

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