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Surgery Subspecialties > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Pterygium

A

non-cancerous growth of the conjunctiva that lays over the sclera
- caused by UV damage, wind exposure

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2
Q

uveitis

A

swelling, irritation of the uvea (which is the iris, ciliary body, and the chorioid)

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3
Q

3 most common causes of red eye

A

conjunctivitis, uveitis, acute angle glaucoma

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4
Q

halos tend to arise with ______ pathology

A

corneal

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5
Q

ciliary flush, presentation?

A

injection of the deep conjunctival vessels

- p/w uveitis, acute glaucoma, corneal inflammation, Not usually with conjunctivitis

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6
Q

Purulent/mucopurulent discharge suggests ______

A

bacterial conjunctivitis

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7
Q

copious purulent discharge, potentially blinding

A

GC

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8
Q

Serous discharge +/- preauricular node enlargement

A

suggests viral

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9
Q

keratic precipitates (KP) etiology

A

endothelial cellular deposits on the cornea -> uveitis

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10
Q

KP a/w _____

A

sarcoidosis

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11
Q

KP s/sx

A

diffuse haze or colored halos 2/2 corneal edema

- can have localized opacities 2/2 ulcer or keratitis

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12
Q

the depth of the anterior chamber is ___ w/acute angle glaucoma

A

shallow

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13
Q

Describe the pupil size for the following:

  • uveitis
  • acute glaucoma
  • conjunctivitis
A
  • small 2/2 spasm
  • fixed mid-dilation
  • pupil not affected
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14
Q

ddx for acute proptosis (forward displacement of the eye, like in graves)

A
  • cavernous sinus disease

- orbital infection

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15
Q

ddx for chronic proptosis

A
  • thyroid dz

- masses

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16
Q

episcleritis

A

inflammation of the superficial vessels of the sclera

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17
Q

scleritis

A

inflammation of the deep vessels of the sclera

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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
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19
Q

pterygium tx

A

surgical tx + anti-inflammatory eye drops

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20
Q

Corneal ulcer w/hypopyon (WBCs in anterior chamber)

A

possibly infection

requires heavy duty abx

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21
Q

hyphema

  • def
  • causes
A
  • blood in the anterior chamber
  • 2/2 DM, trauma
    Must be worked up - look for perforation
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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
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23
Q

If pt has red eye but denies pain, halos, and photophobia, think ____

A

conjunctivitis

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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)
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25
Q

what are the 4 risks of topical steroids?

A
  • masks inflammation
  • potentiates keratitis
  • cataract formation
  • elevated IOP
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26
Q

UNEQUAL PUPILS =

A

SERIOUS DISEASE

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27
Q

STAIN WITH ____

A

FLUORESCEIN

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28
Q

If visual acuity is reduced, _____ is unlikely

A

CONJUNCTIVITIS

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29
Q

Corneal edema (acute glaucoma), hyphema (trauma/ab vessels), cataracts, vitreous hemorrhage are all examples dzs w/ ______

A

media opacities

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30
Q

Think of ____ _____ when a patient has DM, SSA, retinal vein occlusion, SAH

A

vitreous hemorrhage

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31
Q

retinal ____ is an emergency

A

detachment

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32
Q

S/sx of retinal detachment/

A
  • flashing lights (photopsia)
  • floaters
  • APD
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33
Q

Amaurosis fugax is a type of ___ dz, and the w/u includes ____ +_____

A
  • retinal
  • echo
  • doppler
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34
Q

S/Sx of central retinal artery occlusion (CRAO)

A

EMERGENCY

  • sudden
  • painless
  • severe vision loss
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35
Q

Retina appears _____ w/CRAO. The macula _____. The optic disc _____

A
  • white
  • cherry red spot
  • does not usually swell
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36
Q

PE findings w/CRVO

  • optic disc
  • blood vessels
  • retina
A
  • disc swelling
  • venous engorgement
  • cotton wool spots
  • flame hemorrhages
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37
Q

Giant cell arteritis tx

A

EMERGENCY

- high dose steroids

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38
Q

What are the different optic nerve diseases

A
  • Giant cell
  • optic neuritis
  • papillitis
  • papilledema
  • ischemic optic neuropathy (altitudinal)
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39
Q

optic neuritis is ____ if it’s progressive

A

retrobulbar

40
Q

papillitis causes

A

decreased vision

41
Q

papilledema causes

A

no visual changes

42
Q

Emergencies

A 
D2GC
retinal Detachment
acute angle Glaucoma
Giant cell arteritis
CRAO
Chemical burns
43
Q

which chemical burns are more serious? Acidic or alkaline?

A

Alkaline

44
Q

If the eye turns red during/after treatment for a chemical burn, what does this indicate?

A

that the eye is responding to the treatment and isn’t totally necrotic yet

45
Q

What type of fracture usually doesn’t cause loss of vision or ocular function?

A

orbial rim fracture

46
Q

Blowout fracture

  • def
  • s/sx
  • tx
A
  • 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
Q

Medial (ethmoid) fractures s/sx

A
  • crepitance

- subq edema of the lid

48
Q

Fractures of optic canal cause

A

damage to optic nerve and vessels

49
Q

Surgical repair required when what sx/conditions are present? (4)

A
  • diplopia
  • downward gaze
  • endophthalmos
  • large fracture
50
Q

Refer a patient with lid lacerations if _____

A

it involves the lid margin or the lacrimal canalicula

51
Q

If a pt has a hyphema always check for _______

A

perforation

52
Q

Lens discoloration, iritis, vitreous hemorrhage, retinal hemorrhage/tears/detachment can all be sequelae of ________

A

blunt trauma

53
Q

Actual or suspected penetrating trauma always requires ________

A

an eye shield!

54
Q

What should you not do in the cases of penetrating trauma? (3)

A
  • patch
  • use ointment
  • order an MRI (metal foreign bodies) - do a CT to locate the FBs
55
Q

Tx for superficial FB

A

0.5% proparacaine + wash

56
Q

Tear drop pupil or flat anterior chamber –> suspect _____

A

perforation

57
Q

____ is the most common cause of blindness in African Americans

A

glaucoma

58
Q

No pain, nausea, halos, red eye, hazy cornea, fixed pupil, or acute vision loss refers to open or closed angle glaucoma?

A

open

59
Q

A normal cup:disc ratio = ______

the ratio that should start raising concern = ___

A
  1. 3

0. 5

60
Q

Normal IOP

A

<21

61
Q 
glaucoma is characterized by: 
- \_\_\_\_ IOP
- cup:disc ratio of \_\_\_\_
- 
-
A
  • increased
  • > 0.5
  • pallor
  • asymmetric cup:disc ratio between eyes
62
Q

Screening for glaucoma

A

q2-4y after 40

q3-5y from 20-39 in AAs

63
Q

_____ is the most common cause of vision loss in the US

A

age related cataracts

64
Q

When is surgery indicated for cataracts?

A

when it interferes with daily fxn

65
Q

____ is the most common cause of irreversible central vision loss >52 yrs

A

age-related macular degeneration (MD)

66
Q

Dry MD indicates_____ and represents ___% of cases

A

no choroid neovascularization

- 90%

67
Q

_____ have been shown to reduce conversion between dry and wet MD

A

vitamins

68
Q

wet MD indicates ______ and presents with _____

A
  • chorioid neovascularization

- sudden vision loss

69
Q

wet MD is treated with

A

Anti-VEGF injections

70
Q

Leukocoria (white reflex) in a child has what DDx? (3)

A
  • cataracts
  • retinoblastoma
  • primary hyperplastic vitreous (HPV)
71
Q

What are the types of amblyopia (lazy eye)? (4)

A
  • strabismic
  • refractive
  • form deprivation
  • occlusive
72
Q

amblyopia develops when ____

A

young children receive visual info from an eye that’s blurred/in conflict with the other and the brain favors the good image

73
Q

amblyopia is treated with _____

A

an eye patch in early childhood

74
Q

____ is the leading cause of blindness in working age Americans

A

Diabetes

75
Q

DM can lead to which ophthalmologic sequelae? (4) Why is DM such a cause for worry?

A
  • cataracts
  • non-proliferative retinopathy
  • severe non-proliferative retinopathy
  • proliferative retinopathy
  • all of these are asx until it’s too late for optimal treatment
76
Q

What is an example of non-proliferative retinopathy in DM patients?

A
  • macular edema, hard exudates, dot and blot hemorrhages
77
Q

Severe non-proliferative retinopathy is characterized by ____ (3)

A
  • increased tortuousity of blood vessels
  • venous beading
  • cotton wool spots
78
Q

proliferative retinopathy in DM patients is the production of new blood vessels in the eye in response to ______. These vessels can lead to ____ (2)

A
  • hypoxia
  • vitreous hemorrhage/subretinal hemorrhage
  • traction retinal detachment
79
Q

Whats the tx of proliferative retinopathy

A

laser to the retina

80
Q

Buzzwords for AIDS

A

Cotton wool spots (2/2 microthrombi)

CMV retinitis

81
Q

____ is the leading cause of visual loss in AIDS because it can cause ____ (3)

A

CMV retinitis

  • retinal hemorrhages,
  • white opacification
  • floaters
82
Q

What is hutchinson sign and what does it imply in the case of ophtho?

A

herpes zoster on the tip of the nose

- higher risk of eye being infected

83
Q

keratitis and anterior uveitis are both _____

A

eye threatening lesions

84
Q

How does HTN affect the eye?

A
  • arteriolar sclerosis –> increase in the white reflex (copper wiring)
85
Q

acutely elevated BP can cause ____ (4)

A
  • fibrinoid necrosis of the vessel wall
  • splinter hemorrhages
  • exudates
  • cotton wool spots
86
Q

Malignant HTN can cuase

A

disc swelling

87
Q

what effects does pregnancy have on the eye? (3)

A
  • lower IOP
  • transient loss of accommodation
  • decreased corneal sensation
88
Q

pregnant pts w/DM should see the ophthalmologist how frequently?

A

1x/trimester

89
Q

Buzzword: hyperthyroidism (2)

A

corneal exposure, drying

90
Q

Buzzword: sarcoid (5)

A
  • anterior/posterior uveitis (tx w/steroids)
  • optic neuropathy
  • oculomotor problems
  • dry eye (also in SLE, RA)
  • FOCAL, NONCASEATING GRANULOMAS
91
Q

cancer in the eye often comes from (4)

A

breast mets
lung mets
leukemia
lyphoma

92
Q

Buzzword: syphilis

A

acute interstitial keratitis w/keratouveitis

93
Q

What are the sx/sequelae of acute interstitial keratitis w/keratouveitis from syphilis?

A
  • intense pain
  • photophobia
  • diffusely opaque cornea w/reduced vision
  • late chorioretinitis
94
Q

if someone presents with acute interstitial keratitis w/keratouveitis from syphilis what should you always do and why?

A
  • Check CSF for neurosyphilis
95
Q

how does candida infection of the eye present?

A

fluffy white superficial infiltrate, vitreous haze

96
Q

how to treat candida in the eye?

A

amphotericin

Surgery Subspecialties (6 decks)

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