Ophthalmology Flashcards
(96 cards)
1
Q
Pterygium
A
non-cancerous growth of the conjunctiva that lays over the sclera
- caused by UV damage, wind exposure
2
Q
uveitis
A
swelling, irritation of the uvea (which is the iris, ciliary body, and the chorioid)
3
Q
3 most common causes of red eye
A
conjunctivitis, uveitis, acute angle glaucoma
4
Q
halos tend to arise with ______ pathology
A
corneal
5
Q
ciliary flush, presentation?
A
injection of the deep conjunctival vessels
- p/w uveitis, acute glaucoma, corneal inflammation, Not usually with conjunctivitis
6
Q
Purulent/mucopurulent discharge suggests ______
A
bacterial conjunctivitis
7
Q
copious purulent discharge, potentially blinding
A
GC
8
Q
Serous discharge +/- preauricular node enlargement
A
suggests viral
9
Q
keratic precipitates (KP) etiology
A
endothelial cellular deposits on the cornea -> uveitis
10
Q
KP a/w _____
A
sarcoidosis
11
Q
KP s/sx
A
diffuse haze or colored halos 2/2 corneal edema
- can have localized opacities 2/2 ulcer or keratitis
12
Q
the depth of the anterior chamber is ___ w/acute angle glaucoma
A
shallow
13
Q
Describe the pupil size for the following:
- uveitis
- acute glaucoma
- conjunctivitis
A
- small 2/2 spasm
- fixed mid-dilation
- pupil not affected
14
Q
ddx for acute proptosis (forward displacement of the eye, like in graves)
A
- cavernous sinus disease
- orbital infection
15
Q
ddx for chronic proptosis
A
- thyroid dz
- masses
16
Q
episcleritis
A
inflammation of the superficial vessels of the sclera
17
Q
scleritis
A
inflammation of the deep vessels of the sclera
18
Q
why and how to distinguish episcleritis vs. scleritis
A
- episcleritis - doesn’t need to be worked up. PHENYLEPHRINE causes redness to go away, nonpainful
- scleritis - must be worked up since it could have an underlying cause. Phenylephrine won’t work, painful
19
Q
pterygium tx
A
surgical tx + anti-inflammatory eye drops
20
Q
Corneal ulcer w/hypopyon (WBCs in anterior chamber)
A
possibly infection
requires heavy duty abx
21
Q
hyphema
- def
- causes
A
- blood in the anterior chamber
- 2/2 DM, trauma
Must be worked up - look for perforation
22
Q
Chalazion
- def
- management
- possible cause
A
- Cyst in the eyelid,
- Must drain, chronic, non-painful
- blepharitis can lead to this - must treat and clean eye lid
23
Q
If pt has red eye but denies pain, halos, and photophobia, think ____
A
conjunctivitis
24
Q
Why do you not want to prescribe topical anesthetics? When would you use them?
A
- they inhibit corneal healing, allergic rxns, and eliminate the protective blink reflex
- only use for dx (bc it inhibits the blink reflex)
25
what are the 4 risks of topical steroids?
- masks inflammation
- potentiates keratitis
- cataract formation
- elevated IOP
26
UNEQUAL PUPILS =
SERIOUS DISEASE
27
STAIN WITH ____
FLUORESCEIN
28
If visual acuity is reduced, _____ is unlikely
CONJUNCTIVITIS
29
Corneal edema (acute glaucoma), hyphema (trauma/ab vessels), cataracts, vitreous hemorrhage are all examples dzs w/ ______
media opacities
30
Think of ____ _____ when a patient has *DM*, SSA, retinal vein occlusion, SAH
vitreous hemorrhage
31
retinal ____ is an emergency
detachment
32
S/sx of retinal detachment/
- flashing lights (photopsia)
- floaters
- APD
33
Amaurosis fugax is a type of ___ dz, and the w/u includes ____ +_____
- retinal
- echo
- doppler
34
S/Sx of central retinal artery occlusion (CRAO)
EMERGENCY
- sudden
- painless
- severe vision loss
35
Retina appears _____ w/CRAO. The macula _____. The optic disc _____
- white
- cherry red spot
- does not usually swell
36
PE findings w/CRVO
- optic disc
- blood vessels
- retina
- disc swelling
- venous engorgement
- cotton wool spots
- flame hemorrhages
37
Giant cell arteritis tx
EMERGENCY
| - high dose steroids
38
What are the different optic nerve diseases
- Giant cell
- optic neuritis
- papillitis
- papilledema
- ischemic optic neuropathy (altitudinal)
39
optic neuritis is ____ if it's progressive
retrobulbar
40
papillitis causes
decreased vision
41
papilledema causes
no visual changes
42
Emergencies
```
D2GC
retinal Detachment
acute angle Glaucoma
Giant cell arteritis
CRAO
Chemical burns
```
43
which chemical burns are more serious? Acidic or alkaline?
Alkaline
44
If the eye turns red during/after treatment for a chemical burn, what does this indicate?
that the eye is responding to the treatment and isn't totally necrotic yet
45
What type of fracture usually doesn't cause loss of vision or ocular function?
orbial rim fracture
46
Blowout fracture
- def
- s/sx
- tx
- fracture of the orbital floor - maxillary, palatine, and zygomatic bones
- may cause limited vertical eye motion and diplopia 2/2 EOM entrapment. Decreased sensation of teeth and cheek on ipsilateral side. Risk ascending infection
- immediate surgery
47
Medial (ethmoid) fractures s/sx
- crepitance
| - subq edema of the lid
48
Fractures of optic canal cause
damage to optic nerve and vessels
49
Surgical repair required when what sx/conditions are present? (4)
- diplopia
- downward gaze
- endophthalmos
- large fracture
50
Refer a patient with lid lacerations if _____
it involves the lid margin or the lacrimal canalicula
51
If a pt has a hyphema always check for _______
perforation
52
Lens discoloration, iritis, vitreous hemorrhage, retinal hemorrhage/tears/detachment can all be sequelae of ________
blunt trauma
53
Actual or suspected penetrating trauma always requires ________
an eye shield!
54
What should you not do in the cases of penetrating trauma? (3)
- patch
- use ointment
- order an MRI (metal foreign bodies) - do a CT to locate the FBs
55
Tx for superficial FB
0.5% proparacaine + wash
56
Tear drop pupil or flat anterior chamber --> suspect _____
perforation
57
____ is the most common cause of blindness in African Americans
glaucoma
58
No pain, nausea, halos, red eye, hazy cornea, fixed pupil, or acute vision loss refers to open or closed angle glaucoma?
open
59
A normal cup:disc ratio = ______
| the ratio that should start raising concern = ___
0. 3
| 0. 5
60
Normal IOP
<21
61
```
glaucoma is characterized by:
- ____ IOP
- cup:disc ratio of ____
-
-
```
- increased
- >0.5
- pallor
- asymmetric cup:disc ratio between eyes
62
Screening for glaucoma
q2-4y after 40
| q3-5y from 20-39 in AAs
63
_____ is the most common cause of vision loss in the US
age related cataracts
64
When is surgery indicated for cataracts?
when it interferes with daily fxn
65
____ is the most common cause of irreversible central vision loss >52 yrs
age-related macular degeneration (MD)
66
Dry MD indicates_____ and represents ___% of cases
no choroid neovascularization
| - 90%
67
_____ have been shown to reduce conversion between dry and wet MD
vitamins
68
wet MD indicates ______ and presents with _____
- chorioid neovascularization
| - sudden vision loss
69
wet MD is treated with
Anti-VEGF injections
70
Leukocoria (white reflex) in a child has what DDx? (3)
- cataracts
- retinoblastoma
- primary hyperplastic vitreous (HPV)
71
What are the types of amblyopia (lazy eye)? (4)
- strabismic
- refractive
- form deprivation
- occlusive
72
amblyopia develops when ____
young children receive visual info from an eye that's blurred/in conflict with the other and the brain favors the good image
73
amblyopia is treated with _____
an eye patch in early childhood
74
____ is the leading cause of blindness in working age Americans
Diabetes
75
DM can lead to which ophthalmologic sequelae? (4) Why is DM such a cause for worry?
- cataracts
- non-proliferative retinopathy
- severe non-proliferative retinopathy
- proliferative retinopathy
- all of these are asx until it's too late for optimal treatment
76
What is an example of non-proliferative retinopathy in DM patients?
- macular edema, hard exudates, dot and blot hemorrhages
77
Severe non-proliferative retinopathy is characterized by ____ (3)
- increased tortuousity of blood vessels
- venous beading
- cotton wool spots
78
proliferative retinopathy in DM patients is the production of new blood vessels in the eye in response to ______. These vessels can lead to ____ (2)
- hypoxia
- vitreous hemorrhage/subretinal hemorrhage
- traction retinal detachment
79
Whats the tx of proliferative retinopathy
laser to the retina
80
Buzzwords for AIDS
Cotton wool spots (2/2 microthrombi)
| CMV retinitis
81
____ is the leading cause of visual loss in AIDS because it can cause ____ (3)
CMV retinitis
- retinal hemorrhages,
- white opacification
- floaters
82
What is hutchinson sign and what does it imply in the case of ophtho?
herpes zoster on the tip of the nose
| - higher risk of eye being infected
83
keratitis and anterior uveitis are both _____
eye threatening lesions
84
How does HTN affect the eye?
- arteriolar sclerosis --> increase in the white reflex (copper wiring)
85
acutely elevated BP can cause ____ (4)
- fibrinoid necrosis of the vessel wall
- splinter hemorrhages
- exudates
- cotton wool spots
86
Malignant HTN can cuase
disc swelling
87
what effects does pregnancy have on the eye? (3)
- lower IOP
- transient loss of accommodation
- decreased corneal sensation
88
pregnant pts w/DM should see the ophthalmologist how frequently?
1x/trimester
89
Buzzword: hyperthyroidism (2)
corneal exposure, drying
90
Buzzword: sarcoid (5)
- anterior/posterior uveitis (tx w/steroids)
- optic neuropathy
- oculomotor problems
- dry eye (also in SLE, RA)
- FOCAL, NONCASEATING GRANULOMAS
91
cancer in the eye often comes from (4)
breast mets
lung mets
leukemia
lyphoma
92
Buzzword: syphilis
acute interstitial keratitis w/keratouveitis
93
What are the sx/sequelae of acute interstitial keratitis w/keratouveitis from syphilis?
- intense pain
- photophobia
- diffusely opaque cornea w/reduced vision
- late chorioretinitis
94
if someone presents with acute interstitial keratitis w/keratouveitis from syphilis what should you always do and why?
- Check CSF for neurosyphilis
95
how does candida infection of the eye present?
fluffy white superficial infiltrate, vitreous haze
96
how to treat candida in the eye?
amphotericin
