Ophthalmology

Question 1

Amblyopia

Answer 1

Vision impairment from interference w/ image processing during first 6-7 years. Strabismus is common expression. Brain sees two overlapping images, supresses one. If no corect strabismus, permanent cortical blindness of supressed eye, even though eye is normal. If obstacle impedes vision in early years (congen cataract), same problem. CRAZY!

Question 2

Strabismus

Answer 2

Verify by shwoing that reflection of light comes from diff areas of cornea in each eye. Correct surgically to prevent ambylopia. If child develops strabis later in infancy, problem - exgg convergence caused by refrac difficulties. Then corrective glasses. True strabis does not reverse spontaneously

Question 3

White pupil in baby

Answer 3

Optho EMERGENCY! Might be retinoblastoma. Even if it is less lethal, like congen cataract, still operate (prevent amblyopia)

Question 4

Glaucoma

Answer 4

Very common source of blindness, but silent, so hard to be discovered by PCP. One variant = acute angle closure glaucoma shows up as svere eye pain/frontal h/a in the evening after pupils dilated for several hours. Pt sees halos around light, on p/e pupil id-dilated no react light, cornea cloudy w/ greenish hue, eye is rock-hard. Emergency tx- ophto drills into anterior chamber. While waiting, give systemic carbonic anhydrase inhib (Diamox), topical beta-block + alpha2-agonists. Also manitol/pilocarpine

Question 5

Orbital cellulitis

Answer 5

Optho emergency. Eyelids hot, tender, red, swollen, febrile patiet. Pry open eye and see dilated/fixed pupil, with limited motion. Pus in the orbit, need emergent CT and drainage

Question 6

Chemical burns of eye

Answer 6

Require massiv eirrigation, plain water ASAP (dont wait till hospital. Pry it open, wash for 1/2 hour, go to ER, irrigate w/ saline, remove hidden corrosive particles, and pH test conjunctival sac. Base worse than acid

Question 7

Retinal detachment

Answer 7

EMERGENCY! Pt sees flashes of light and has floaters. More floaters, mo problem. 1-2 floaters = vitreous tugging @ retina, but dozens or big dark cloud at top of visual field has big horseshoe piece of retina pulled away, risk of ripping out rest. Do spot welding laser beam (for remaining retina)

Question 8

EEmbolic occlusion of retinal artery

Answer 8

EMERGENCY, but can’t do much. Sudden loss of vision in one eye, in 30 min, damange irreversible. Have pt breathe into paper bag and press hard on the eye/release (vasodilate + shake clot more distally)

Question 9

New diabetes (optho)

Answer 9

Do optho eval for type II b/c might already have retinal damage if dx is just actually late. Tx can prevent progression. Kids w/ type I will get eye problems in 20 years