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PANCE > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Ectropion definition

A

eyelid/lashes are turned OUTWARD (everted)

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2
Q

Entropion definition

A

eyelid/lashes turned INWARD (inverted)

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3
Q

Dacryocystitis definition and location

A

infection of lacrimal sac located on the MEDIAL CANTHAL (NASAL) side of lower lid area

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4
Q

Dacryocystitis S/S

A

Tearing, unilateral, PAINFUL edema, erythema, and warmth to nasal side of lower lid area

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5
Q

Acute TX of Dacryocystitis

A

Warm compresses + ABX

Clindamycin if mild, Vanc + Ceftriaxone if severe

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6
Q

What is the patho of posterior blepharitis?

A

Meibomian gland dysfunction

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7
Q

S/S of blepharitis?

A

Crusting, scaling, red-rimming of eyelid with flaking on lashes or lid margins

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8
Q

TX of blepharitis

A

Mainstay –> Eyelid hygiene (warm compresses, eyelid scrubbing, lid washing with baby shampoo)

If severe –> Topical ABX (Azithromycin ointment, Erythromycin, Bacitracin)

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9
Q

What is MCC of hordeolum

A

Staph aureus

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10
Q

What is TX of hordeolum?

A

Mainstay –> Warm compresses
If no spontaneous drainage after 48h –> I&D
+/- topical ABX ointment (Erythromycin or Bacitracin) if active drainage

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11
Q

What is a chalazion

A

Painless, larger, firmer, slow-growing indurated granuloma d/t obstruction of Zeis or Meibomian glands

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12
Q

What is TX of chalazion

A

Conservative –> Eyelid hygiene, warm compresses

Refractory –> Ophthal referral for injection of glucocorticoids

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13
Q

What is a pinguecula

A

Yellow, slightly elevated nodule on nasal side of sclera

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14
Q

What conditions increase risk of pinguecula?

A

Dry, windy, sunny conditions; ocular trauma

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15
Q

What is a pterygium

A

Elevated, superficial, fleshy, triangular-shaped growing fibrovascular mass

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16
Q

What increases risk of pterygium?

A

UV exposure, sand, wind, dust exposure

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17
Q

What is a globe rupture?

A

Blunt/penetrating trauma disrupts outer membranes of eye - OPHTHAL EMERGENCY

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18
Q

What are s/s of globe rupture? 6 things

A

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

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19
Q

What is TX for globe rupture?

A 
Rigid eye shield to protect eye
IV ABX
Tetanus PPX
Emergent opthal consult
\+/- CT scan of eye without contrast
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20
Q

What is MC type of orbital “blowout” fracture?

A

Inferior (floor, blowout)

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21
Q

What is patho of inferior floor blowout fracture?

A

Orbital fat and/or inferior rectus muscle prolapse into maxillary sinus

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22
Q

What are S/S of orbital floor blowout fracture?

A

Decreased visual acuity
Diplopia with upward gaze (inferior rectus muscle entrapment)
Orbital emphysema
Anesthesia to anteromedial cheek (stretching of infraorbital nerve)

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23
Q

What finding is seen on CT scan of orbital floor blowout fracture?

A

“Teardrop” sign - inferior herniation of orbital fat

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24
Q

What is TX of orbital floor blowout fractures?

A

Ampicillin-Sulbactam or Clindamycin
Nasal decongestants (decrease pain)
Corticosteroids (reduce edema)
Avoid blowing nose/sneezing

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25
Q

What gene is a/w retinoblastoma?

A

RB1 gene

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26
Q

What are s/s of retinoblastoma?

A

Leukocoria (presence of abnormal white reflex instead of normal red reflex), strabismus, nystagmus

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27
Q

What is MC type of macular degeneration?

A

Dry (atrophic)

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28
Q

What is the timing of dry and wet macular degneration?

A

Dry –> Progressive over decades

Wet –> More rapid and aggressive (within months)

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29
Q

What are S/S of macular degneration?

A

Bilateral, progressive, CENTRAL VISION LOSS (including detail and color vision)
Central scotomas
Metamorphopsia (straight lines appear bent)

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30
Q

What is seen on funduscopic exam of dry mac degeneration?

A

Drusen bodies (small round yellow-white spots on outer retina; localized deposits of extracellular material)

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31
Q

What is seen on funduscopic exam for wet mac degeneration?

A

New, abnormal vessels that cause retinal hemorrhaging and scarring

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32
Q

TX of dry macular degeneration?

A

Zinc, Antioxidant, Vitamin C and E

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33
Q

TX of wet mac degeneration?

A 
VEGF Inhibitors (Bevacizumab, Ranibizumab)
Laser photocoagulation
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34
Q

What s/s are seen in non-proliferative diabetic retinopathy?

A

Microaneurysms
Cotton wool spots (soft exudates, fluffy, gray-white spots)
Hard exudates (yellow spots with sharp margins)
Blot and dot hemorrhages
Flame-shaped hemorrhages

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35
Q

How to prevent diabetic retinopathy?

A

Diabetics should have annual eye exams

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36
Q

What are s/s of mild hypertensive retinopathy?

A

Arteriolar narrowing
Abnormal light reflexes on dilated tortuous arteriole
Copper wiring
AV nicking

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37
Q

Hypertensive retinopathy moderate S/S are same as diabetic retinopathy =

A

Flame or dot-shaped hemorrhages, cotton wool spots, hard exudates, microaneurysms

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38
Q

What is severe hypertensive retinopathy s/s? (GRADE IV?

A

Both mild and moderate s/s + PAPILLEDEMA (blurring of optic disc)

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39
Q

What are RF of retinal detachment?

A

Myopia

Previous cataract surgery

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40
Q

What are S/S of retinal detachment?

A

Photopsia (flashing lights) –> floaters –> progressive, unilateral PERIPHERAL vision loss
“Curtain coming down” in periphery

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41
Q

What is seen on funduscopy for retinal detachment?

A

Retinal tear (detached tissue “flapping” in vitreous humor)

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42
Q

What positive sign is seen with retinal detachment?

A

Shafer’s sign = Clumping of brown-colored pigment in anterior vitreous humor resembling “tobacco dust”

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43
Q

TX of retinal detachment

A

Keep patient supine, OPTHAL EMERGENCY

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44
Q

What is MCC of neonatal conjunctivitis in first 2-5 days of life?

A

Gonococcal

TX: IM/IV Ceftriaxone

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45
Q

What is MCC of neonatal conjunctivitis in first 5-7 days of life?

A

Chlamydia trachomatis

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46
Q

What is TX for Chlamydia neonatal conjunctivitis?

A

Oral Erythromycin once sx occur

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47
Q

What is the standard neonatal PPX for neonatal conjunctivitis?

A

Erythromycin ointment immediately after birth

48
Q

What does fluoroscein staining show for corneal abrasion?

A

“Ice rink” or linear abrasion

Relief with analgesic drops

49
Q

What is TX for non-contact lens wearer corneal abrasion and ocular FB?

A

Erythromycin ointment, Polymyxin-Trimethoprim, Sulfacetamide

50
Q

What is TX for contact lens wearer ocular FB and corneal abrasion?

A

Cover for Pseudomonas with Topical Ciprofloxacin or Ofloxacin (or Tobramycin or Gentamicin)

51
Q

At one point is patching considered for corneal abrasions?

A

If large corneal abrasion (> 5mm)

52
Q

When should rust-ring be removed for corneal abrasion or FB?

A

Remove rust ring at 24 hours

53
Q

MCC bacterial conjunctivitis?

A

Staph aureus

54
Q

S/S bacterial conjunctivitis?

A

Purulent discharge, lid crusting shut in the morning

55
Q

TX of bacterial conjunctivitis in non-contact lens wearer

A

Erythromycin ointment, Polymyxin B-Trimethoprim, Fluoroquinolone’s (Moxifloxacin, Ofloxacin)

56
Q

TX of bacterial conjunctivitis in contact-lens wearer?

A

Topical Ciprofloxacin or Ofloxacin (or Tobramycin or Gentamicin)

57
Q

MCC of viral conjunctivitis

A

Adenovirus

58
Q

S/S of viral conjunctivitis

A

Copious watery tearing, ipsilateral preauricular LAD

59
Q

TX of viral conjunctivitis

A

Supportive mainstay (warm/cool compress, antihistamines (Olopatadine)

60
Q

S/S of allergic conjunctivitis

A

Red watery eyes, itching

Cobblestoning mucosa, chemosis (conjunctival edema)

61
Q

TX of allergic conjunctivitis

A

Supportive, topical antihistamines (Olopatadine, Pheniramine-Naphazoline)

62
Q

What do ocular alkali chemical burns cause?

A

Liquefactive necrosis, denatures proteins/collagens, thrombosis of vessels (WORSE than acids)

63
Q

What do acidic ocular chemical burns cause?

A

Coagulative necrosis

Substances like cleaners, batteries

64
Q

TX of ocular chemical burns

A 
Immediate irrigation x 30 minutes until neutral pH achieved with LR or NS
Topical ABX (Polymyxin-Trimethoprim, Erythromycin ointment, Moxifloxacin)
65
Q

Esotropia definition

A

Cross-eyed; deviated INWARD (nasally)

66
Q

Exotropia definition

A

Deviated OUTWARD (temporally)

67
Q

What is initial DX for strabismus?

A

Hirschberg corneal light reflex testing –> asymmetric deflection of corneal light reflex in 1 eye

68
Q

Strabismus TX

A

Patch therapy 1st line - Normal eye is covered

69
Q

Orbital (septal) cellulitis S/S

A

Ocular pain with EYE MOVEMENTS
Ophthalmoloplegia (EOM weakness)
Bulging eyes, visual changes

70
Q

DX for orbital (septal) cellulitis

A

CT scan shows infection of fat and ocular muscles behind septum

71
Q

TX for orbital (septal) cellulitis

A

Admission + IV ABX (Vancomycin + Ceftriaxone or Cefotaxime)

Alt: Ampicillin-Sulbactam, Pip-Tazo, Clindamycin

72
Q

Preseptal (periorbital) cellulitis MCC

A

staph aureus (MRSA)

73
Q

preseptal (periorbital) cellulitis S/S

A

Unilateral ocular pain
Eyelid erythema, edema

NO ISSUES WITH OCULAR PAIN WITH EOM, BULGING, OR EOM WEAKNESS

74
Q

TX for preseptal (periorbital) cellulitis for patients older than 1 year and mild disease

A

Outpatient management with PO Clindamycin monotherapy

Alt: Bactrim + Amoxicillin or Augmentin

75
Q

What is MCC of corneal ulcer/bacterial keratitis in contact lens wearers?

A

Pseudomonas

76
Q

What is greatest RF of corneal ulcer/bacterial keratitis development?

A

Improper contact lens wearing

Bells palsy, corticosteroid use

77
Q

Corneal ulcer/bacterial keratitis S/S

A

Ocular pain, FB sensation, eye redness, photophobia, vision changes
Eye redness, ciliary injection (limbal flush), hazy cornea

78
Q

What is seen on slit lamp exam for corneal ulcer/bacterial keratitis?

A

Increased fluroscein uptake

79
Q

What is TX for bacterial keratitis (corneal ulcer)

A 
Topical Fluoroquinolone (Moxifloxacin, Gatifloxacin)
Do NOT patch eye
80
Q

What is sign for herpes keratitis?

A

Dendritic (branching) on fluoroscein staining

81
Q

What is TX for herpes keratitis?

A 
Topical antivirals (Trifluridine, Ganciclovir ointment)
PO Acyclovir
82
Q

What is seen on slit lamp for uveitis?

A

Inflammatory “cells and flare”
Cells = WBCs
Flare = Protein in vitreous humor

83
Q

What are RF for cataracts?

A

Aging, cigarette smoking, DM

84
Q

Congenital ToRCH is a/w what eye disorder?

A

Cataracts

85
Q

S/S of cataracts

A

PAINLESS, slow/progressive, blurred or vision loss

Absent red reflex, opaque lens

86
Q

What is TX for cataracts if visual changes affect ADLs

A

Surgery

87
Q

What is papilledema?

A

Optic nerve (disc) swelling 2nd to increased ICP

88
Q

What causes papilledema?

A

Severe (grade IV) HTN, idiopathic intracranial HTN, cerebral tumor, increased CSF

89
Q

S/S of papilledema

A

Headache, N/V
Enlarged blind spot
Negative Marcus Gunn

90
Q

What does papilledema look like on funduscopic exam?

A

Swollen optic disc with blurred margins

91
Q

What is DX for papilledema?

A

Funduscopic exam
MRI/CT of head (r/o mass effect)
LP –> Increased CSF pressure

92
Q

What is TX for papilledema?

A

Acetazolamide to decrease aqueous humor and CSF production

93
Q

What is optic neuritis?

A

Demyelination of optic nerve (usually unilateral)

94
Q

What is RF for optic neuritis?

A

MULTIPLE SLCEROSIS

Ethambutol (TB med)

95
Q

What is S/S for optic neuritis?

A

PAINFUL, unilateral, loss of vision, decrease in COLOR VISION, central scotoma (blind spot)

96
Q

What PE finding is seen with optic neuritis?

A

Positive Marcus Gunn pupil - relative afferent pupillary defect

97
Q

What is TX for optic neuritis?

A

IV Methylprednisolone 1st line, then PO corticosteroids

98
Q

If a lesion exists on the optic nerve or retina, what is visual pathway defect

A

Total blindness of ipsilateral eye

99
Q

If lesion is lateral to optic chiasm?

A

Ipsilateral nasal hemianopsia

100
Q

If lesion is midline to optic chiasm (at level of optic chiasm)?

A

Bitemporal heteronymous hemianopsia

101
Q

If lesion at optic tract or in occipital lobe stroke?

A

Contralateral homonymous hemianopsia

102
Q

What is patho of acute narrow-angle closure glaucoma?

A

Increased IOP –> damage of optic nerve; decreased drainage of aqueous humor via trabecular network and canal of Schlemm

103
Q

what precipitates narrow angle-closure glaucoma?

A

Mydriasis (pupillary dilation) –> DIM LIGHTS

104
Q

What are S/S of acute narrow-angle closure glaucoma?

A

Sudden severe, UNILATERAL, ocular pain
Vision changes including HALOS AROUND LIGHTS
Loss of PERIPHERAL vision (tunnel vision)

105
Q

What is seen on PE of acute narrow angle-closure glaucoma?

A

Cloud, “steamy” cornea

Mid-dilated fixed pupil that reacts poorly to light

106
Q

What is DX for acute narrow angle closure glaucoma?

A

Tonometry –> Increased IOP > 21

107
Q

What is TX for acute narrow angle-closure glaucoma

A

Topical Timolol +
Topical Apraclonidine +
Topical Pilocarpine +
Systemic Acetazolamide or Mannitol

108
Q

What is DEFINITIVE TX for acute narrow angle-closure glaucoma

A

Iridotomy

109
Q

What is MC presenting symptoms of chronic (open-angle) glaucoma?

A

Usually ASX, may present with vision loss (peripheral vision loss - tunnel vision)

110
Q

What is TX for chronic (open-angle) glaucoma?

A 
Reduce IOP = 
Latanoprost (Prostaglandin analog)
Timolol (BB)
Brimonidine (Alpha-2-agonist)
Acetazolamide (Carbonic anyhydrase inhibitor)
111
Q

What is MCC of central retinal artery occlusion?

A

Emboli from carotid artery atherosclerosis

112
Q

What is S/S for central retinal artery occlusion?

A

Acute, sudden, PAINLESS, unilateral vision loss +/- “curtain coming down”

113
Q

What does funduscopic exam for central retinal artery occlusion show?

A

Pale retina with cherry red macula

Boxcar appearance of retinal vessels

114
Q

What is TX for central retinal artery occlusion?

A

Supportive: CO2 rebreathing, O2, ocular massage, decompression of anterior chamber (Acetazolamide)

POOR PROGNOSIS

115
Q

What is s/s for central retinal vein occlusion?

A

Sudden, PAINLESS, unilateral vision loss

116
Q

What is seen on funduscopic exam for central retinal vein occlusion?

A

Extensive retinal hemorrhages (blood and thunder appearance)

Retinal vein dilation

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