Ophthalmology Flashcards
Ectropion definition
eyelid/lashes are turned OUTWARD (everted)
Entropion definition
eyelid/lashes turned INWARD (inverted)
Dacryocystitis definition and location
infection of lacrimal sac located on the MEDIAL CANTHAL (NASAL) side of lower lid area
Dacryocystitis S/S
Tearing, unilateral, PAINFUL edema, erythema, and warmth to nasal side of lower lid area
Acute TX of Dacryocystitis
Warm compresses + ABX
Clindamycin if mild, Vanc + Ceftriaxone if severe
What is the patho of posterior blepharitis?
Meibomian gland dysfunction
S/S of blepharitis?
Crusting, scaling, red-rimming of eyelid with flaking on lashes or lid margins
TX of blepharitis
Mainstay –> Eyelid hygiene (warm compresses, eyelid scrubbing, lid washing with baby shampoo)
If severe –> Topical ABX (Azithromycin ointment, Erythromycin, Bacitracin)
What is MCC of hordeolum
Staph aureus
What is TX of hordeolum?
Mainstay –> Warm compresses
If no spontaneous drainage after 48h –> I&D
+/- topical ABX ointment (Erythromycin or Bacitracin) if active drainage
What is a chalazion
Painless, larger, firmer, slow-growing indurated granuloma d/t obstruction of Zeis or Meibomian glands
What is TX of chalazion
Conservative –> Eyelid hygiene, warm compresses
Refractory –> Ophthal referral for injection of glucocorticoids
What is a pinguecula
Yellow, slightly elevated nodule on nasal side of sclera
What conditions increase risk of pinguecula?
Dry, windy, sunny conditions; ocular trauma
What is a pterygium
Elevated, superficial, fleshy, triangular-shaped growing fibrovascular mass
What increases risk of pterygium?
UV exposure, sand, wind, dust exposure
What is a globe rupture?
Blunt/penetrating trauma disrupts outer membranes of eye - OPHTHAL EMERGENCY
What are s/s of globe rupture? 6 things
Decreased visual acuity
Enophthalmos
Mis-shapen pupil (tear-drop shape) Prolapse of iris through cornea
+ Seidel’s test (parting of Fluruoscein dye by aqueous humor)
Hyphema
Obscured red reflex
What is TX for globe rupture?
Rigid eye shield to protect eye IV ABX Tetanus PPX Emergent opthal consult \+/- CT scan of eye without contrast
What is MC type of orbital “blowout” fracture?
Inferior (floor, blowout)
What is patho of inferior floor blowout fracture?
Orbital fat and/or inferior rectus muscle prolapse into maxillary sinus
What are S/S of orbital floor blowout fracture?
Decreased visual acuity
Diplopia with upward gaze (inferior rectus muscle entrapment)
Orbital emphysema
Anesthesia to anteromedial cheek (stretching of infraorbital nerve)
What finding is seen on CT scan of orbital floor blowout fracture?
“Teardrop” sign - inferior herniation of orbital fat
What is TX of orbital floor blowout fractures?
Ampicillin-Sulbactam or Clindamycin
Nasal decongestants (decrease pain)
Corticosteroids (reduce edema)
Avoid blowing nose/sneezing
What gene is a/w retinoblastoma?
RB1 gene
What are s/s of retinoblastoma?
Leukocoria (presence of abnormal white reflex instead of normal red reflex), strabismus, nystagmus
What is MC type of macular degeneration?
Dry (atrophic)
What is the timing of dry and wet macular degneration?
Dry –> Progressive over decades
Wet –> More rapid and aggressive (within months)
What are S/S of macular degneration?
Bilateral, progressive, CENTRAL VISION LOSS (including detail and color vision)
Central scotomas
Metamorphopsia (straight lines appear bent)
What is seen on funduscopic exam of dry mac degeneration?
Drusen bodies (small round yellow-white spots on outer retina; localized deposits of extracellular material)
What is seen on funduscopic exam for wet mac degeneration?
New, abnormal vessels that cause retinal hemorrhaging and scarring
TX of dry macular degeneration?
Zinc, Antioxidant, Vitamin C and E
TX of wet mac degeneration?
VEGF Inhibitors (Bevacizumab, Ranibizumab) Laser photocoagulation
What s/s are seen in non-proliferative diabetic retinopathy?
Microaneurysms
Cotton wool spots (soft exudates, fluffy, gray-white spots)
Hard exudates (yellow spots with sharp margins)
Blot and dot hemorrhages
Flame-shaped hemorrhages
How to prevent diabetic retinopathy?
Diabetics should have annual eye exams
What are s/s of mild hypertensive retinopathy?
Arteriolar narrowing
Abnormal light reflexes on dilated tortuous arteriole
Copper wiring
AV nicking
Hypertensive retinopathy moderate S/S are same as diabetic retinopathy =
Flame or dot-shaped hemorrhages, cotton wool spots, hard exudates, microaneurysms
What is severe hypertensive retinopathy s/s? (GRADE IV?
Both mild and moderate s/s + PAPILLEDEMA (blurring of optic disc)
What are RF of retinal detachment?
Myopia
Previous cataract surgery
What are S/S of retinal detachment?
Photopsia (flashing lights) –> floaters –> progressive, unilateral PERIPHERAL vision loss
“Curtain coming down” in periphery
What is seen on funduscopy for retinal detachment?
Retinal tear (detached tissue “flapping” in vitreous humor)
What positive sign is seen with retinal detachment?
Shafer’s sign = Clumping of brown-colored pigment in anterior vitreous humor resembling “tobacco dust”
TX of retinal detachment
Keep patient supine, OPTHAL EMERGENCY
What is MCC of neonatal conjunctivitis in first 2-5 days of life?
Gonococcal
TX: IM/IV Ceftriaxone
What is MCC of neonatal conjunctivitis in first 5-7 days of life?
Chlamydia trachomatis
What is TX for Chlamydia neonatal conjunctivitis?
Oral Erythromycin once sx occur
What is the standard neonatal PPX for neonatal conjunctivitis?
Erythromycin ointment immediately after birth
What does fluoroscein staining show for corneal abrasion?
“Ice rink” or linear abrasion
Relief with analgesic drops
What is TX for non-contact lens wearer corneal abrasion and ocular FB?
Erythromycin ointment, Polymyxin-Trimethoprim, Sulfacetamide
What is TX for contact lens wearer ocular FB and corneal abrasion?
Cover for Pseudomonas with Topical Ciprofloxacin or Ofloxacin (or Tobramycin or Gentamicin)
At one point is patching considered for corneal abrasions?
If large corneal abrasion (> 5mm)
When should rust-ring be removed for corneal abrasion or FB?
Remove rust ring at 24 hours
MCC bacterial conjunctivitis?
Staph aureus
S/S bacterial conjunctivitis?
Purulent discharge, lid crusting shut in the morning
TX of bacterial conjunctivitis in non-contact lens wearer
Erythromycin ointment, Polymyxin B-Trimethoprim, Fluoroquinolone’s (Moxifloxacin, Ofloxacin)
TX of bacterial conjunctivitis in contact-lens wearer?
Topical Ciprofloxacin or Ofloxacin (or Tobramycin or Gentamicin)
MCC of viral conjunctivitis
Adenovirus
S/S of viral conjunctivitis
Copious watery tearing, ipsilateral preauricular LAD
TX of viral conjunctivitis
Supportive mainstay (warm/cool compress, antihistamines (Olopatadine)
S/S of allergic conjunctivitis
Red watery eyes, itching
Cobblestoning mucosa, chemosis (conjunctival edema)
TX of allergic conjunctivitis
Supportive, topical antihistamines (Olopatadine, Pheniramine-Naphazoline)
What do ocular alkali chemical burns cause?
Liquefactive necrosis, denatures proteins/collagens, thrombosis of vessels (WORSE than acids)
What do acidic ocular chemical burns cause?
Coagulative necrosis
Substances like cleaners, batteries
TX of ocular chemical burns
Immediate irrigation x 30 minutes until neutral pH achieved with LR or NS Topical ABX (Polymyxin-Trimethoprim, Erythromycin ointment, Moxifloxacin)
Esotropia definition
Cross-eyed; deviated INWARD (nasally)
Exotropia definition
Deviated OUTWARD (temporally)
What is initial DX for strabismus?
Hirschberg corneal light reflex testing –> asymmetric deflection of corneal light reflex in 1 eye
Strabismus TX
Patch therapy 1st line - Normal eye is covered
Orbital (septal) cellulitis S/S
Ocular pain with EYE MOVEMENTS
Ophthalmoloplegia (EOM weakness)
Bulging eyes, visual changes
DX for orbital (septal) cellulitis
CT scan shows infection of fat and ocular muscles behind septum
TX for orbital (septal) cellulitis
Admission + IV ABX (Vancomycin + Ceftriaxone or Cefotaxime)
Alt: Ampicillin-Sulbactam, Pip-Tazo, Clindamycin
Preseptal (periorbital) cellulitis MCC
staph aureus (MRSA)
preseptal (periorbital) cellulitis S/S
Unilateral ocular pain
Eyelid erythema, edema
NO ISSUES WITH OCULAR PAIN WITH EOM, BULGING, OR EOM WEAKNESS
TX for preseptal (periorbital) cellulitis for patients older than 1 year and mild disease
Outpatient management with PO Clindamycin monotherapy
Alt: Bactrim + Amoxicillin or Augmentin
What is MCC of corneal ulcer/bacterial keratitis in contact lens wearers?
Pseudomonas
What is greatest RF of corneal ulcer/bacterial keratitis development?
Improper contact lens wearing
Bells palsy, corticosteroid use
Corneal ulcer/bacterial keratitis S/S
Ocular pain, FB sensation, eye redness, photophobia, vision changes
Eye redness, ciliary injection (limbal flush), hazy cornea
What is seen on slit lamp exam for corneal ulcer/bacterial keratitis?
Increased fluroscein uptake
What is TX for bacterial keratitis (corneal ulcer)
Topical Fluoroquinolone (Moxifloxacin, Gatifloxacin) Do NOT patch eye
What is sign for herpes keratitis?
Dendritic (branching) on fluoroscein staining
What is TX for herpes keratitis?
Topical antivirals (Trifluridine, Ganciclovir ointment) PO Acyclovir
What is seen on slit lamp for uveitis?
Inflammatory “cells and flare”
Cells = WBCs
Flare = Protein in vitreous humor
What are RF for cataracts?
Aging, cigarette smoking, DM
Congenital ToRCH is a/w what eye disorder?
Cataracts
S/S of cataracts
PAINLESS, slow/progressive, blurred or vision loss
Absent red reflex, opaque lens
What is TX for cataracts if visual changes affect ADLs
Surgery
What is papilledema?
Optic nerve (disc) swelling 2nd to increased ICP
What causes papilledema?
Severe (grade IV) HTN, idiopathic intracranial HTN, cerebral tumor, increased CSF
S/S of papilledema
Headache, N/V
Enlarged blind spot
Negative Marcus Gunn
What does papilledema look like on funduscopic exam?
Swollen optic disc with blurred margins
What is DX for papilledema?
Funduscopic exam
MRI/CT of head (r/o mass effect)
LP –> Increased CSF pressure
What is TX for papilledema?
Acetazolamide to decrease aqueous humor and CSF production
What is optic neuritis?
Demyelination of optic nerve (usually unilateral)
What is RF for optic neuritis?
MULTIPLE SLCEROSIS
Ethambutol (TB med)
What is S/S for optic neuritis?
PAINFUL, unilateral, loss of vision, decrease in COLOR VISION, central scotoma (blind spot)
What PE finding is seen with optic neuritis?
Positive Marcus Gunn pupil - relative afferent pupillary defect
What is TX for optic neuritis?
IV Methylprednisolone 1st line, then PO corticosteroids
If a lesion exists on the optic nerve or retina, what is visual pathway defect
Total blindness of ipsilateral eye
If lesion is lateral to optic chiasm?
Ipsilateral nasal hemianopsia
If lesion is midline to optic chiasm (at level of optic chiasm)?
Bitemporal heteronymous hemianopsia
If lesion at optic tract or in occipital lobe stroke?
Contralateral homonymous hemianopsia
What is patho of acute narrow-angle closure glaucoma?
Increased IOP –> damage of optic nerve; decreased drainage of aqueous humor via trabecular network and canal of Schlemm
what precipitates narrow angle-closure glaucoma?
Mydriasis (pupillary dilation) –> DIM LIGHTS
What are S/S of acute narrow-angle closure glaucoma?
Sudden severe, UNILATERAL, ocular pain
Vision changes including HALOS AROUND LIGHTS
Loss of PERIPHERAL vision (tunnel vision)
What is seen on PE of acute narrow angle-closure glaucoma?
Cloud, “steamy” cornea
Mid-dilated fixed pupil that reacts poorly to light
What is DX for acute narrow angle closure glaucoma?
Tonometry –> Increased IOP > 21
What is TX for acute narrow angle-closure glaucoma
Topical Timolol +
Topical Apraclonidine +
Topical Pilocarpine +
Systemic Acetazolamide or Mannitol
What is DEFINITIVE TX for acute narrow angle-closure glaucoma
Iridotomy
What is MC presenting symptoms of chronic (open-angle) glaucoma?
Usually ASX, may present with vision loss (peripheral vision loss - tunnel vision)
What is TX for chronic (open-angle) glaucoma?
Reduce IOP = Latanoprost (Prostaglandin analog) Timolol (BB) Brimonidine (Alpha-2-agonist) Acetazolamide (Carbonic anyhydrase inhibitor)
What is MCC of central retinal artery occlusion?
Emboli from carotid artery atherosclerosis
What is S/S for central retinal artery occlusion?
Acute, sudden, PAINLESS, unilateral vision loss +/- “curtain coming down”
What does funduscopic exam for central retinal artery occlusion show?
Pale retina with cherry red macula
Boxcar appearance of retinal vessels
What is TX for central retinal artery occlusion?
Supportive: CO2 rebreathing, O2, ocular massage, decompression of anterior chamber (Acetazolamide)
POOR PROGNOSIS
What is s/s for central retinal vein occlusion?
Sudden, PAINLESS, unilateral vision loss
What is seen on funduscopic exam for central retinal vein occlusion?
Extensive retinal hemorrhages (blood and thunder appearance)
Retinal vein dilation