Ophthalmology Flashcards
Macular degeneration is characterized by gradual loss of […] vision.
Macular degeneration is characterized by gradual loss of central vision.
versus open angle glaucoma, which is characterized by gradual loss of peripheral vision
What is the gold standard tool for diagnosis of acute angle closure glaucoma?
gonioscopy or tonometry
allows for visualization of the iridocorneal angle; tonometry can be helpful if urgent ophthalmological consult is unavailable
What is the initial treatment for central retinal artery occlusion?
Ocular massage and high-flow O2 administration
What is the initial treatment for external hordeolum (stye)?
Warm compresses
persistent hordeolum (> 1-2 weeks) or large chalazions may be managed with incision and curettage
What is the likely diagnosis in a diabetic patient that presents with decreased vision in both eyes? Ophthalmoscopy reveals microaneurysms, dot and blot hemorrhages, hard exudates, and macular edema.
Diabetic retinopathy
patient has simple retinopathy; can progress to pre-proliferative (with cotton wool spots) and proliferative (newly formed vessels) retinopathy
What is the likely diagnosis in a diabetic patient that presents with sudden-onset loss of vision in the right eye? Ophthalmoscopy reveals loss of fundus details, floating debris, and a dark red glow.
Vitreous hemorrhage
typically presents with sudden loss of vision and onset of floaters in a patient with diabetic retinopathy; differentiated from retinal detachment by loss of fundus details*
What is the likely diagnosis in a patient that presents with “floating spots” and blurred vision in the right eye? Several weeks ago, the patient had a penetrating injury to his left eye, causing vision loss.
Sympathetic ophthalmia (“spared eye injury”)
due to an immunologic mechanism involving the recognition of “hidden antigens”
What is the likely diagnosis in a patient that presents with a hard, painless bump on the upper eyelid?
Chalazion
typically caused by granulomatous reaction to a blocked meibomian gland; may be more common in patients with ocular rosacea
What is the likely diagnosis in a patient that presents with a red, tender bump on the upper eyelid?
Hordeolum (stye)
usually caused by Staphylococcus aureus
What is the likely diagnosis in a patient that presents with sudden onset flashes of light and floaters in the left eye? The patient felt like “a curtain came down” over her eye. Ophthalmoscopy reveals a grayish-appearing retina.
Retinal detachment
What is the likely diagnosis in a patient that presents with sudden onset severe pain in the left eye, accompanied by blurred vision, nausea, and vomiting? The left eye appears red, with a hazy cornea, and dilated, fixed pupil. It is hard to the touch.
Acute angle closure glaucoma
tonometry reveals increased IOP; IV acetazolamide may lower intraocular pressure, though permanent cure may require laser peripheral iridotomy
What is the likely diagnosis in a patient that presents with tenderness, edema, and redness over the medial canthus of the right eye for two days? Slight pressure over the area causes expression of purulent material.
Dacryocystitis (infection of the lacrimal sac)
typically caused by Staphylococcus aureus and Streptococcus pyogenes
What is the likely diagnosis in a patient that wears contacts and presents with sudden-onset eye pain and discharge? On examination, there is thick, globular yellow discharge. The cornea is hazy and ulcerated.
Contact lens-associated keratitis
typically due to gram-negative organisms (e.g. Pseudomonas, Serratia); occasionally due to gram-positives, fungi, or amoebas
What is the likely diagnosis in a patient with a gritty sensation and watery discharge from the right eye for 3 days? The patient also has rhinorrhea, mild sore throat, and low-grade fever. Eye examination reveals conjunctival injection.
Viral conjunctivitis
What is the likely diagnosis in a patient with a history of asthma that presents with sudden onset redness, watery discharge, and itching of both eyes?
Allergic conjunctivitis
What is the likely diagnosis in a patient with a history of IBD that presents with a painful, red eye with tearing and decreased visual acuity?
Anterior uveitis
typically idiopathic but may be associated with IBD, sarcoidosis, and spondyloarthritis
What is the likely diagnosis in a patient with a history of poorly controlled HIV that presents with floaters and blurred vision? Funduscopic examination reveals yellow-white exudates adjacent to the fovea and retinal vessels.
CMV retinitis
CMV is painless and characterized by perivascular lesions (vs HSV, which is painful and characterized by peripheral pale lesions and central retinal necrosis)
What is the likely diagnosis in an elderly patient with progressive vision loss over several months? When the patient is asked to look at a small spot on a grid made of vertical and horizontal lines, he describes the vertical lines as bent and wavy.
Macular degeneration
ophthalmologic examination may reveal drusen deposits in the macula
What is the likely diagnosis in an elderly patient with sudden loss of vision in the left eye? Funduscopic examination reveals swelling of the optic disk, retinal hemorrhages, dilated and tortuous veins, and cotton wool spots.
Central retinal vein occlusion
“blood and thunder” appearance on funduscopy; CRVO is typically less acute than central retinal artery occlusion
What is the next step in management for a patient that woke up with a “red eye” (pictured below)? He does not complain of any symptoms.
Observation
spontaneous subconjunctival hemorrhages are benign and require no treatment
What is the recommended treatment for viral conjunctivitis?
warm or cold compresses
versus topical antibiotics (e.g. erythromycin) for bacterial conjunctivitis and mast cell stabilizing agents (e.g. olopatadine, azelastine) for frequent allergic conjunctivitis
Primary open angle glaucoma is characterized by gradual loss of […] vision and pathologic cupping of the optic disc on ophthalmoscopy.
Primary open angle glaucoma is characterized by gradual loss of peripheral vision and pathologic cupping of the optic disc on ophthalmoscopy.
versus macular degeneration, which is characterized by gradual loss of central vision
[…] is characterized by gradual loss of peripheral vision and pathologic cupping of the optic disc on ophthalmoscopy.
Primary open angle glaucoma is characterized by gradual loss of peripheral vision and pathologic cupping of the optic disc on ophthalmoscopy.
versus macular degeneration, which is characterized by gradual loss of central vision
