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Clin Med II - Exam 1 > ophthalmology > Flashcards

ophthalmology Flashcards

1
Q

xanthelasmas

A

aka xanthelasma palpebrum
etiology - hyperlipidemia, esp high LDL in young adults
presentation - soft yellow-orange plaques on eyelids or medial canthus
check for atheroscelorosis

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2
Q

scleral icterus

A

jaundice of the sclera
(NOT melanin deposits in african americans)
check for s&s of liver of hemolytic diseases

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3
Q

thyrotoxicosis

A

s&s - stare, exophthalmos, goiter
check for lids lag, tachycardia, moist velvety warm skin, fine hair, detachment of nail from nail bed (onycholysis), exposure keratitis
systemic disease - thyroid (AKA graves disease)

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4
Q

marcus -gunn pupil

A

afferent pupillary defect

consensual response normal on both sides but direct abnormal on affected side

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5
Q

adie’s pupil

A

large, unilateral pupil
slow accommodation and reaction to light
reduced reaction to light

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6
Q

argyll-robertson pupil

A

accommodate but do no react to light

sign of syphillis

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7
Q

horner’s syndrome

A

ptosis, miosis - pupil small but briskly reacts to light and accommodation, and anhidrosis

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8
Q

pterygium

A

etiology - constant exposure to sun, wind, sand, or dust
pathophysiology - may interfere with vision
s&s - triangular-shaped, fleshy path of conjunctival tissue encroaching onto cornea, often bilateral, can become inflamed and may grow, eye redness and irritation
tx - none required if no vision threatening growth, induction of astigmatism or severe irritation (surgery)
- prolonged symptoms - lubricating eyedrops, short course topical NSAIDs or weak steroid eyedrops

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9
Q

pinguecula

A

s&s - yellow, slightly-raised, conjunctival nodule near palpebral fissure, often bilateral and common in pts under 35, no corneal involvement, inflammation common
tx - none required, prolong - lubricating eyedrops, short course topical NSAIDs, weak steroid eyedrops

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10
Q

viral conjunctivitis

A

aka pink eye
etiology - adenovirus, highly contagious
-2ndary to HSV, enterovirus, coxsackievirus
s&s - bilateral with copious, watery discharge, foreign body sensation, palpable pre-auricular LAD possible
tx - self limited except for HSV (normal - 10-14 days)
- 2ndary bacterial infection -topical anti-bacterials
- cool compresses, topical antihistamine, vasoconstrictor

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11
Q

bacterial conjunctivitis

A

etiology : s. aureus., strept. pneumoniae, haemophilus spp., pseudomonas spp. moraxella spp.
s&s - copious, purulent discharge, no blurring, mild discomfort
tx - self limiting but topical antibiotics clears in 2-3 days vs 10-14 days

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12
Q

gonococcal conjunctivitis

A

etiology - n. gonorrhoeae
pathophysiology - infected genital secretion, often during birth
s&s - copius, purulent discharge, corneal involvement can quickly lead to corneal perforation -> occular emergency
dx - stained smear and culture of the D/C
REFER
tx - systemic ceftriazone via IV with corneal involvement and IM if cornea not involved
- oral antibiotics after loading ceftriazone - erythromycin, tetracycline or doxycycline
- cover for chlamydia exposure

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13
Q

Neonatal conjunctivitis

A

chemical - irrigate ASAP
bacterial - gonorrhoeae, staph, strep
chlamydia
viruses incl. herpes

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14
Q

allergic conjunctivitis

A

benign conditions that appears during late childhood, may be seasonal, perennial or contact allergy
S&S - itchy, tearing, redness, stringy mucoid discharge, conjunctival hyperemia and edema, occasionally photophobia and vision loss
dx - clinical
tx - symptom relief
1st line - topical H1 receptor antagonist QID for several days
more sever - topical mast cell stabilizer - cromolyn sodium or lodoxamide
topical vasoconstrictor/antihistamine combo, systemic antihistamines - loratidine, systemic corticosteriods

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15
Q

vernal keratoconjunctivitis

A

teens and young adults, seasonal
S&S - b/l conjunctival inflammation, photophobia, intense itchy, systemic atophy
PE - large cobblestone papillae on upper tarsal conjunctiva, corneal involvement frequent incl. refractory ulceration
tx - topical steroids, allergic onjunctivitis tx and cooler climate

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16
Q

atopic keratoconjunctivitis

A

chronic disorder in adulthood
potential staphylococcal blepharitis
corneal involvement frequent
complicated by herpes simplex keratitis

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17
Q

dacryoadenitis

A

inflammation or lacrimal glands
acute - infection
chronic - inflammatory disorders - thyroid disease, orbital swelling, sarcoidosis

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18
Q

keratoconjunctivitis sicca

A

dry mouth, eyes, mucous membrane w/o connective tissue disorder
risks - elderly women, sjogren’s syndrome, rheumatoid arthritis, stevens-johnson syndrome, systemic meds and environmental conditions

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19
Q

schirmer test

A

basal and reflex lacrimal gland function

20
Q

tear deficiency states

A

tears - lubricate, bacteriostatic
s7s - burning, foreign body sensation, reflex tearing
tx - artificial tears usual TID, QID (preferably without preservatives), lubricating ointmenta hs, more sever - anti-inflammatory or punctal occlusion

21
Q

keratitis

A

inflammation of cornea
secondary to infection, foreign body causing abrasion, exposure
s&S - pain photophobia, tearing, reduced vision, red eye, circumcorneal injection, purulent or watery discharge, hypopyon (bacterial s&s)

22
Q

bacterial keratitis

A

usually after corneal injury
p. aeruginosa, pneumococcus, moraxella, staphy.
gram stain and culture with empiric fluoroquinolone
change rx - to high conc. topical antibiotics
gram + - cephalosporine
gram - aminoglycoside or fluoroquinolone
for contact lens wearers - pain and tearing in early AM due to corneal edema, risk for pseudomonas species or acanthamoeba species
education - don’t swim while wearing contacts

23
Q

topical steroids and eye side effects

A

advance corneal penetration by herpesvirus, elevates IOP -> steroid-induced glaucoma
risk for cataracts

24
Q

exposure keratitis

A

bell’s palsy, proptosis
etiology - incomplete lid closure - leads to drying out
tx - lubricating solutions and ointments, tape lids shut at night
NO patching -> improperly done, gauze can scratch cornea

25
Q

actinic keratitis

A

UV light damages cornea due to exposure with symptoms 6-12 hrs later
risk - lack of eye protection - welder’s arc, sunlamps, snow blindness

26
Q

herpes simplex virus

A

can cause conjunctivitis, keratitis, blepharitis
tx - oral acyclovir
topical acyclovir or ganciclovir
antivirals with topical steroids to reduce corneal opacity
worst case - corneal grafting
risk of recurrences so prophylaxis for immunocompromised pts

27
Q

herpes zoster ophthalmicus

A

infection of the ophthalmic division of CN V
etiology - varicella zoster virus
presentation - malaise, fever, HA, periorbital burning and itching, rash develops 1-2 days post sxs - vesicles, pustules, crusting
dx - fluorescin stain - dendritic ulcer - braches ending in knobs
tx - check HIV status if needed, REFER
- oral antivirals at high does - 72 hrs of rash onset - acyclovir, valacyclovir, famciclovir
posterior uveitis - topical steriods okay - no corneal involvement
if over 60 and not immunocompromised, shingles vaccination indicated
intraocular involvement suspicion - tip of nose or eyelid margins have vesicles

28
Q

scleritis

A

inflammation of the sclera
mostly anterior, sometimes in isolation, 50% with systemic disease
s&s - deep boring pain that may radiate
- deep vessels non-blanchable, violaceous injection,
systemic disease - connective tissue disorder
may involve cornea, adjacent episclear and underlying uveal tract
2/3 rquire high dose glucocorticoids plus possibly immunosuppresive agent or risk of blindness due to destruction

29
Q

episcleritis

A

abrupt onset of inflammation of episclera, mild and isolated, self-limited or responds to topical therapies, non vision threatening, mostly healthy adult females

30
Q

orbital cellultitis

A

rapid onset,
external - redness and welling, EOM impaired and painful, possible proptosis or optic nerve affected - decr. vision, afferent pupillary defect, disc edema
tx - hospitalize, eye consult, blood cultures, CT scan, IV empiric antibiotics vs. staph, strep, h. influenzae ASAP
surgical debridement -fungal, no improvement, subperiosteal abscess
complications - cavernous sinus thrombosis, meningitis

31
Q

perioribital cellulitis

A

no proptosis, normal EOMS and vision, skin disruption - trauma, bites, etc.

32
Q

hordeolum

A

aka sy
suppurative inflammation of gland of hair follice of eyelid
etiology - blockage prevents normal drainage leading to bacteria entrapment normally of staph aureus
risks- poor hygiene, chronic illness, previous hordeola
internal- points onto conjunctival surface and can lead to generalized eyelid cellulitis
s&s - redness, swelling, pain, tenderness, tearing, blurred vision, foreign body sensation
tx - warm compresses, antibiotic ointment, I&D if no improvement in 48 hrs

33
Q

chalazion

A

chronic inflammatory granuloma of a meibomian gland/ tarsal gland
hard, nontender swelling of eyelid with associated redness and swelling of conjunctiva
tx- I&D, steroid injections
may develop following internal hordeolum

34
Q

blepharitis

A

common, chronic b/o inflammatory condition of lid margins
anterior- skin, lashes, glands
posterior - meibomian glands
common cause of recurrent conjunctivitis
tx - keep lid margins, eyebrows, scalp clean
antibiotic eye ointments - bacitracin, erythromycin
longterm, lose dose systemic for some posterior cases, short-term topical corticosteroids if indicated

35
Q

entropion

A

inward turning of lower lid, risk - age due to degeneration of lid fascia, scarring of conjunctiva or tarsus
surgery if risk of corneal abrasion

36
Q

ectropion

A

outward turning of lower eyelid common with advancing age

surgery for excessive tearing, keratitis, cosmeticerior cham

37
Q

acute angle-closure glaucoma

A

s&s - severe eye pain w/ rapid onset and frontal HA
- blurred vision w/halos around lights
- abd pain and nausea
PE - red eye, cornea steamy; pupil moderately dilated and non-reactive to light
- IOP markedly elevation
- crescent shadow of anterior chamber
- gonioscopy by ophthalmologists to visualize angle
- if untreated w/in 2-5 days of symptoms, permanent and severe vision loss

38
Q

primary acute angle-closure glaucoma

tx

A

-previously narrow anterior chamber angle closes
tx - initial acetazolamide mg IV follow by PO acetazolamide QID
- no success -> osmotic diuresis, laser therapy or anterior chamber paracentesis to lower IOP
Once IOP starts to lower - topical pilocarpine to reverse angle closure
surgical tx - iridotomy or iridectomy

39
Q

secondary acute angle-closure glaucoma

tx

A

seen w/ anterior uveitis, lens dislocation, topiramate therapy
systemic acetazolamide maybe with osmotic agents, tx underlying cause

40
Q

chronic glaucoma

A

chronically elevated IOP
s&s- progressive loss of peripheral vision with visual acuity preserved
PE - optic disc cupping or asymmetry of cup:disc ratio
- central vision good
preventative - screen pts >40 Q2-5 years
- screen DM of +FH annually
tx - PG analogs of topical beta-adrenergic blocking agents with or w/o alpha-agonist agents
- medical failure to tx - laser or surgery
if untreated can cause complete blindness in 15-20 yrs

41
Q

hypertnesive retinopathy

A
  • excessively high bp can cause small retinal blood vessels to leak, bulge, thicken and become damaged leading to hemorrhages, hard and soft exudates and edema
  • if choroidal circulation is affected - vasoconstriction, ischemia, retinal infarcts, retinal detachments
  • venous compression at arteriovenous crossing- AV nicking
  • AV nicking can predispose for branch retinal vein occulsions and retinal bleeds
  • graded 1-4 with only 6% survival of pts with grade 4 after 3 yrs OR mild - severe grading
  • presents w/o visual symptoms
  • tx - steady, consistent BP control
  • if acute BP elevations cause HTN retinopathy don’t treat too rapidly or aggressively
42
Q

diabetic retinopathy

A

types:
1. non-proliferative - dilated veins, small aneurysms, bleeding, edema, hard exudates in retina
2. background retinopathy - mild retinal abnormalities
3. maculopathy - macular edema, exudates, ischemia, most common cause of legal blindness in type II DM
4. proliferative- retinal neovascularization, proliferations into vitreous bv can cause retinal detachment, w/o tx bad prognosis compared to non-proliferative, laser surgery tx
prevention:
1. Type 1 DM - 5 yrs after dx
2. Type 2 DM - at dx
3. women with DM and pregnant - early and Q2-3 months
4. tx - DM, HTN, lipid level control with good renal fcn

43
Q

retinal detachment

A

separation of neurosensory layer from retinal pigment epithelium, sub-retinal fluid accumulates under neurosensory layer
risks - myopia, cataract surgery hx, ocular trauma, fhx, 50 yo+
s&s - new onset floaters or incr. in floaters, phtopsia
- curtain spreading vision loss or sudden unilateral vision loss in periphery
- no pain or erythema
PE- check visual acuity, visual fields, pupils, trauma signs
- ophthalmoscopic exam - retina hanging like a cloud, one+ tears
tx - ocular emergency, refer, cover eye and void pressure
- goal: close tears and adhere neurosensory and epithelium of retinea to choroid via laser photocoagulation or cryotherapy, with injection of expansile gas into vitreos cavity possibly first
prognosis - 90% cases cured w/ one operation unless incr. duration of detachment or macular detachment, w/o tx - loss of vision

44
Q

rhegmatogenous

A

most common type of retinal detachment due to a tear

often spontaneous and related to changes in the vitreous as we age

45
Q

traction retinal detachment

A
  • pre-retinal fibrosis due to diabetic retinopathy or retinal vein occulsion
46
Q

serous or exudative retinal detachment

A

accumulation of fluid beneath retina causes partial break or tear
neovascular ARMD or choroidal tumors can cause this

Clin Med II - Exam 1 (3 decks)

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