Ophthalmology Flashcards
One-year-old child is suspected of having strabismus. You verify that indeed the corneal reflection from a bright light in your examination room comes from different places from each of his eyes.
A two-year-old child is diagnosed with a congenital cataract obstructing his vision in the right.
What is your concern?
The brain learns to see what the eyes see during early infancy up to about age 7. If one I cannot see due to any kind of obstruction or the brain does not like what they see and double vision, the brain will refuse to process the image and that cortical blindness will be permanent. Amblyopia
18 month old baby one of the pupils is white where the other is black.
Leukocoria at this age can be retinoblastoma. Maybe innocent like a cataract, kids still needs it corrected to avoid amblyopia.
53-year-old woman in the ER complaining of extremely severe frontal headache and nausea. Pain started one hour ago, shortly after she left the movies wishy-washy double feature. On further questioning she reports seeing halos around the lights in the parking lot when leaving the theater. On physical examination the peoples are mid dilated and do not react to light; the corneas are cloudy and with a greenish hue, and the eyes feel hard as a rock. What is it? What is the management?
Classic description of acute glaucoma. Ophthalmologist is needed right away – start treatment with systemic carbonic anhydrase inhibitors, topical beta blockers, alpha-2 selective adrenergic agonist. Mannitol and pilocarpine may also be used.
A 32-year-old woman presents to the ER with swollen, red, hot, tender eyelids on the left eye. She has fever and leukocytosis. When prying the eyelids open, you can ascertain that her pupil is dilated and fixed and that she has very limited motion of that left eye. What is it? What is the management?
Orbital cellulitis – pus behind the eye.
Ophthalmologic emergency requires immediate consultation. CT scan indicated to assess the extent of the orbital infection, surgical drainage will follow.
A frantic mother reaches you on the phone, reporting that her 10-year-old boy accidentally splashed Drano on his face and is screaming in pain, complaining that his right eye hurts terribly.
Instruct the mother to pry open the eye under the cold water from the tap at home, irrigate for about half an hour before she brings the kids to the hospital.
More irrigation in the ER, remove solid matter, recheck the pH, check the eyelid for remaining bits of Drano
A 59-year-old, myopic gentleman reports seeing flashes of light at night when the eyes are closed. Further questioning reveals that he also sees floaters during the day, that they number 10 or 20, that he also sees a cloud at the top of his visual field.
Retinal detachment. More than a dozen floaters is an ominous sign, and that cloud at the top of the visual field is hemorrhage settling at the bottom of the eye.
Emergency. Retina specialist will use laser treatment to spot weld the retina and prevent further detachment
77-year-old man suddenly loses sight from the right eye. He calls you on the phone 10 minutes after the onset of the problem. He reports no other neurological symptoms. What is it? What is the management?
Embolic occlusion of the retinal artery.
Take an aspirin and breathe into a paper bag on route to the emergency room, have someone press hard on his eye and release it repeatedly.
55-year-old man with diabetes reports that sometimes after a heavy dinner the television becomes blurry, and he has to squint to see it clearly. What is it?
The lens swells and shrinks in response to swings in blood sugar– Get regular ophthalmologic follow up for retinal complications. It takes 10 or 20 years for these to develop, but type two diabetes may have been present that long before it was diagnosed
Initial treatment for acute angle closure glaucoma?
Oral or intravenous carbonic anhydrase inhibitors, topical beta blockers, alpha-2 selective adrenergic agonist. Osmotic diuretics may also be needed.
Definitive treatment for acute angle closure glaucoma
Laser peripheral iridotomy
What is iridotomy?
A surgical procedure that makes an incision in the IRIS to enlarge the pupil or to treat acute angle closure glaucoma
Initial treatment for acute angle closure glaucoma?
Oral or intravenous carbonic anhydrase inhibitors, topical beta blockers, alpha-2 selective adrenergic agonist. Osmotic diuretics may also be needed.
Definitive treatment for acute angle closure glaucoma
Laser peripheral iridotomy
What is iridotomy?
A surgical procedure that makes an incision in the IRIS to enlarge the pupil or to treat acute angle closure glaucoma
Initial treatment for acute angle closure glaucoma?
Oral or intravenous carbonic anhydrase inhibitors, topical beta blockers, alpha-2 selective adrenergic agonist. Osmotic diuretics may also be needed.
