Ophthalmology Flashcards
Mx of Stye (hordeolum)
Warm compress to speed up process of bursting. If non resolving, do curettage
Dendritic ulcers are seen in?
Viral keratitis
Treatment for acute closed angle glaucoma
Apraclonidine, timolol, pilocarpine, azetazolamide. Laser iridotomy is definitive.
Two ways to investigate closed angle glaucoma. Mention what they measure
Tonometry (pressure), gonioscopy (corneal angle)
Relief of Shoulder pain when place hand on head…. Diagnostic of what
Cervicle radiculopathy.
Tx of cervicle radiculopathy
Conservative
First Signs of macular degeneration, and contrast this for dry and wet
For dry, our central scotoma . For wet, it’s more straight line distortion
Halos at night, is a sign of what?
Cataracts
When to treat cataracts
When it affects life
In strabismus is it normal to have one eyes red reflex more intense
Yes
General Mx for open angle glaucoma
Topical latanoprost first. Then add topical timolol as a step up. If that doesn’t work consider laser therapy. (Tim and his Latino)
Patient has impact to eye/branch in eye etc…. What’s the best invx and why
Flouresin stain…. To Dx abrasion, but also to rule out open globe laceration!!
What are boxcar retinal vessels, where do we see them
In central retinal artery occlusion. Essentially segmentation of the vessels
Tx for retinal detachment
Laser Tx and cryo Tx. To adhere the neursensory retina and RPE
Tremorlous iris with movement of eye left and right, is a sign of?
Lens dislocation
Intial Mx of corneal pH burn. (Bleach for eg.)
Irrigate with normal saline… use litmus to ensure pH normal
What is blepharitis . Some of the causes
Inflam of the eye lid margin. Due to seb derm, HSV, staph, rocasea, allergy, dermodex
What is dacryostenosis. Mx?
Stenosis of the nasolacrimal duct in infants. Massage the duct
Differences in presentation between viral conj and allergic conj
Viral conj : bilateral or unilateral, usually prodrome before, and has 5 days of continuous symptoms
Allergic conj : always bilateral, often atopic and has exposure, intermittent for longer
Strabismus, cover test? And Tx. Significance of 4 month old mark. Red reflex sign.
Where you cover normal eye and see the bad eye move medially . Tx with corrective lenses if bad eye has low visual acuity, and patch cover the good eye to strengthen the bad eye to prevent ambylopia. Only Dx at >4 mo old. Red reflex will be present but greater in the bad eye
How to distinguish between vitreous hemorrhage and optic nerve injury after head injury
Red reflex remains in optic nerve injury, whereas it’s gone in vitreous hem
Invx and Tx for optic nerve injury scodanry to head injury
Ct orbit. Then do conservative therapy, and some may need surgical decompression
Two ways a patient can get traumatic optic nerve damage
Penetrative (usually surgery) or in head injury where the shearing forces transmit to optic canal
What is neonatal chemical conjunctivitis and what causes it? Mx?
Often from silver nitrate being given for gonorrhoea prophylaxis. This is banned in the US though. Presents in first 24 hours, Tx with eye lubrication
Periorbital echymosis (raccoon eyes) suggests?
Orbital fracture
Acute corneal opacification is a sign of what
Acute closed angle glaucoma
Signs of acute global perforation
Fixed teardrop pupil, low acuity, low IOP, extrusion of AH (seen on floruensin), RAPD,
Causes of subconj hem and Tx
Sneeze, cough, HTN, rubbing eye, coagulopathy. Just observe (very benign)
Young patient has strabismus… what needs to be ruled out
Rb…. Do a dilated fundo exam
Hordeolum vs charlazion
H - granulomatous inflam on eye lid. Painless but uncomfortable nodule
C - abscess on eye, localised
How does dacryostenosis present, and how is it managed
Presents with excess Eye tearing and discharge. May even cause eyelash/eyelid crusty. You can do a fluorescent dye, which will show the fluorescent dripping down the cheek and not draining. Management is to massage daily, and if unresolved in six months surgery
What is ambylopia And what are its causes
Essentially a reduced vision due to a vision issue in that eye. So either cataracts, strabismus, refractive error will cause cortical changing to enhance the other eyes vision., but will then neglect the bad eye.
Quick recap on some of the ophthalmological Checks we do in infants and children
Shortly after birth the eyes fixate on stuff. Around three months eyes should be tracking. We should also be doing red reflex testing and strabismus checking. At around 3 to 4 years old we can do visual acuity testing with Snellen chart. 20 out of 40 is concerning for refractive error. Up at five years old 30/40 as concerning
If a patient who had cataract surgery starts to get blood vision, what is this most likely
Posterior capsule opacification. To get cataracts again after surgery is highly unlikely
What is a traumatic hyphema, and what’s the treatment
Blood collection between the cornea and the lens. Usually from blunt trauma, rarely penetrative. Use an eye shield, bed rest, elevate head, glucocorticoid eyedrop. And monitor pressure since glaucoma is a complication
What is the treatment for a trachoma
Azithromycin orally conclude the chlamydial infection. The whole village should be treated in theory. If the patient has trichiasis, then surgery is required of course
 Most common cause of vitreous haemorrhage and how does it present
Most common course is a diabetic retinopathy. Present with loss of vision in one eye, a decrease perception to light, decrease fundal details (SOS), floaters, and a red glow on fundoscopy
How to manage CMV retinitis
Must start ganciclovir. Lesions near the surveyor or optic nerve require direct injection. A couple of weeks after this treatment we can start antiretroviral therapy if AIDS patient
Mention the three main causes of keratitis (infectious), and a sentence on how to distinguish them
HSV – Immuno compromised, watery discharge, dendritic alteration on fluorescent
Staph/pseudomonas – In foreign body or contact lens wearers, will be purulent
Candida – in amino compromised, with soil exposure. Feathery margins and satellite lesions
Hutchinson’s sign for Hsv opthalmicus
If the vesicles of shingles involve the nose tip, it will likely involve the eye
Name three different techniques to treat central retinal artery occlusion
Anterior chamber paracentesis, ocular massage, revascularisation. Remember to do ultrasound of the carotid valuate for stenosis
Contrast the appearance of vision loss in a central retinal artery occlusion and retinal detachment
In retinal artery occlusion we tend to get vertical dropping of the visual field. In retinal detachment we have curtains across (both sides peripherally to central)
Anterior vs posterior uveitis symptoms
Anterior causes eye redness and pain
Posterior is painless and causes floaters
Other than CVT, what are other causes of cavernous sinus syndrome
Pituitary mass, fistula
Orbital blowout fracture. Risk of what
Inferior rectus and orbital fat entrapment. Infraorbital nerve can be caught too
First order horners syndrome causes
Pontine hemorrhage. Lateral medullary syndrome. Spinal cord lesion above T1. Late syringomuelia
What else can cause Marcus Gunn apart from MS
GCA
In Papilledema. What else can be seen on Fundoscopy
Dilated tortuous veins
Retinitis pigmentosa is associated with what genetic disease
Abetaliproteinemia
Papilledema in a HTN patient? Do what
This is malignant HTN. So must immediately lower BP
Black spots and cobweb shapes in visual field
Vitreous haemorrhage
Curtain down over eye vision. Sudden, and flashing lights. Had preceding floaters
Retinal haemorrhage
Causes of central retinal artery occlusion
AF, Behcets, GCA, SCD,
Biggest risk factor for central vein occlusion in retina
HTN
Drugs causing optics neuritis
Methanol, ethambutol, linezolid, infliximab
Fundoscopy finding in optic neuritis
Usually normal, but can have Disc swelling similar to papilledema
Metamorphopsia
Straight lines appear wavy. Seen early on in age related macular degen
Headache worsened by darkness vs brightness
Brightness is obviously migraine. But darkness could be closed angle glaucoma
Myopia needs what lens?
Concave
Hyperopia needs which lens
Convex
Keratitis Dx test and what we see
Slitlamp. And will see white clumps (WBCs in the anterior chamber or vitreous chamber)
Redness and pain of eye. Especially seen at limbus .
Anterior uveitis
Main complication of acute dacrocysttitis
Orbital cellulitis
Bac causing acute dacryocystitis
Strep and staph
Bac causing contact lens keraitis
Pseudomonas
Orbital cellulitis vs periorbital cellulitis
Orbital has: painful eye movement, lower acuity, Diplopia, proptosis, RAPD
Patient with orbital cellulitis and signs of nasal or mucosal ulceration or ethmoidao/maxillary sinusitis….
Mucormycosis or Rhizopus
Dacro cystitis, Maine bacterial cause
Strep and staff
First line for open-angle glaucoma
Latanoprost. Timolol also ok
What is blepharitis.
Inflammation of the eyelid Marjan. Just to warm compress and lid massage
Treatment for neo Nate chlamydial conjunctivitis
Oral erythromycins.
Overview of symptoms for acute globe perforation
Decrease security, teardrop pupil, fluid moving out from the eye. RAPD. Drop in intraocular pressure.
If a patient has strabismus, what sort of investigation should I do
Should do a funduscopic exam, to rule out things like retinoblastoma
Name some infectious causes of keratitis
Pseudomonas, staphylococcus, Canada, HSV
Keratitis with linear Dritic alteration
Dendritic alteration. HSV
Somebody with keratitis with soil exposure, feathery margins and satellite lesions
Candida
Someone has bleeding in the joint, but the coagulation studies and LFTs a normal. They also had a gastric bypass surgery six months ago
Could be scurvy.
