Ophthalmology Flashcards
Amblyopia? Causes? Diagnoses? Management?
Poor vision caused by abnormal visual stimulation
- Eye misalignment (strabismus) – suppression of nonpreferred eye
- Any condition that causes of blurred visual image (cataract, Anisometropia, vitreous hemorrhage
- In preverbal children – bilateral red reflex test is best test
- In older children – formal acuity
- Correct refractory errors
- Patching
Red reflex finding:
- Dark, dull, or white reflex
- Dark or dull reflex
- Yellow or white reflex
- Unequal red reflex
- Bright or red reflex in deviated eye
- Dull reflect
- Cataract
- Vitreous hemorrhage
- Retinoblastoma
- Anisometropia (Significant differences in refractive errors between eyes)
- Strabismus (Lazy eye)
- Glaucoma
Chemical conjunctivitis?
Chemical irritation to eyes due to traps/appointment as prophylactic against Neisseria (especially 1% silver nitrate)
Causes and timescale of conjunctivitis newborns? Tx?
- Within 24 hours – chemical (watery discharge) – no treatment
- 2-4 days of life – Neisseria (purulent discharge, swelling, Corneal ulcer) – topical erythromycin, IV cefotaxime
- 4-10 days – Chlamydia (discharge, lid swelling) – Oral erythromycin
- 6 days to 2 weeks – HSV (unilateral service discharge) – acyclovir, topical trifluorothymidine
Causes of red, teary eyes in newborns other than conjunctivitis?
- Congenital glaucoma
- Dacyrocystitis (infection of nasolacrimal sac)
- Endopthalmitis – can result in blindness
Unilateral conjunctivitis associated with?
Foreign body, corneal ulcer, herpes simplex keratitis
Clinical features of conjunctivitis (Discharge, itching, preauricular lymphadenopathy, labs)
- Bacterial
- Viral
- Allergic
- Blepharitis
- Purulent, non-pruritic, no lymphadenopathy, Gram stain
- Watery, pruritic, lymphadenopathy, none
- Watery/mucoid, pruritic, no lymphadenopathy, eosinophils
- None, none, none, staph aureus on culture
Blepharitis – Causal organism? Clinical features? Management?
staff aureus
- Burning, crusting, scales
- Hyperemic eyelid margins
- Broken/absent eyelashes
- History of awakening in the morning with eyelashes stuck together
Eyelid hygiene, topical erythromycin
Causal organisms of
- Bacterial conjunctivitis
- Viral conjunctivitis
- H. influenzae, strep pneumo, Moraxella, staph aureus
2. Adenovirus
Epidemic keratoconjunctivitis – Cause? Features? Management?
Andenovirus
- Petechial conjunctival hemorrhage
- preauricular lymphadenopathy
- pseudomembrane on conjunctiva
- Photophobia
Supportive
Primary ocular HSV – Clinical features?
- Skin eruption with multiple vesicular lesions
2. Cornual ulcer (rarely)
Causes of hemorrhagic conjunctivitis?
H influenza, adenovirus, picornavirus
Causes of abnormal tearing?
- Nasolacrimal duct obstruction
2. Aminotocele
Cause of nasolacrimal duct obstruction? Management?
Failure of complete canalization of lacrimal system
- Observation (half resolved within six months)
- Nasolacrimal massage/topical antibiotics
- Nasolacrimal duct probing
Amniotocele – Definition? Cause? Clinical features? Management?
Swelling of nasolacrimal sac; nasolacrimal duct obstruction
- Bluish swelling in medial canthal area
- Infection
- Local massage
- As about it and nasolacrimal duct probing
Causes of ocular trauma?
- Retinal hemorrhages
- Corneal abrasion
- Hyperemia (blood within anterior chamber)
- Orbital floor fracture
Retinal hemorrhage suggestive of? Other etiologies?
Child-abuse; increased ICP, hypertension, endocarditis, birth trauma, leukemia
Hyphema – definition? causes? Clinical features? Complications?
Blood in anterior chamber of eye
- Blunt trauma
- Non-traumatic – neovascularization, tumors
- Impaired vision
- blood-aqueous fluid level
Rebleeding 3 to 5 days after injury, glaucoma, optic nerve damage (and sickle cell)
Findings in orbital floor fracture?
- Diplopia (from entrapment of inferior rectus muscle), strabismus
- Numb cheek and teeth (Infraorbital nerve injury)
Normal intraocular pressure in infants? In infants with congenital glaucoma?
Adult glaucoma versus congenital glaucoma?
10-15; >30
Increased intraocular pressure the damages optic nerve
versus
injures optic nerve and expands the size of eye (Results in corneal edema, corneal clouding, amblyopia)
Mechanism for increased Intraocular pressure in congenital glaucoma? Causes of congenital glaucoma?
Reduced outflow of aqueous humor because of maldevelopment of trabecular meshwork
- Infection – congenital rubella
- Ocular abnormalities – aniridia
- Genetic syndromes – Sturge-Weber, neurofibromatosis, Marfan
Clinical features of congenital glaucoma? Management?
Tearing, photophobia, enlarged cornea, corneal clouding, dull-red reflex
Surgery almost always required. Beta-adrenergic and carbonic anhydrase inhibitors may help to lower intraocular pressure
Retinopathy of prematurity? Risk factors? Management? Prevention?
Proliferation of vessels in premature infants exposed to oxygen
High oxygen exposure, low birth weight, transfusions, surfactant deficiency, intracranial hemorrhage
If severe, retinal cryotherapy and laser therapy
- Minimizing oxygen delivered and effective treatment of highland membrane disease
- Premature infants should have eye exam at 5 weeks
Causes of congenital cataracts? Prognosis?
- Genetic – down, Noonan, Marfan, Alport
- Metabolic – hypoglycemia, galactosemia, diabetes
- Infection – CMV, rubella
Surgery performed over two months of age is associated with poor visual outcome
Retinoblastoma – age? Chromosome? Two most common presenting signs? Hallmark of retinoblastoma? Clinical signs? Treatment of very small tumors? Small tumors? Large tumors?
13-18 months; chromosome 13
Leukocoria and strabismus
Calcification within the tumor
Glaucoma, vitreous hemorrhage, retinal detachment, hyphema
- Cryotherapy or laser photocoagulation
- External beam radiation
- If it involves macula – remove whole eye
Leukocoria? Suggestive of?
White pupil – suggest opacity at/behind pupil
- Cataract
- Retinoblastoma
- Opacity within the vitreous
Strabismus? Types?
Misalignment of the eyes
- Esotropia – eye turned nasally
- Exotropia – eye turned laterally
- Vertical
- Pseudostrabismus – Prominence of epicanthal folds result in false appearance of strabismus
Strabismus in pt under six years versus over six years? Tx?
Child suppresses image in deviated eye (resulting in amblyopia)
versus
unable to suppress image in Deviated eye (resulting in diplopia)
- Patching
- If associated with farsightedness, Initially treated with corrective lenses
- Surgery if no response
