Ophthalmology Flashcards
Pterygium
non-cancerous growth of the conjunctiva that lays over the sclera
- caused by UV damage, wind exposure
uveitis
swelling, irritation of the uvea (which is the iris, ciliary body, and the chorioid)
3 most common causes of red eye
conjunctivitis, uveitis, acute angle glaucoma
halos tend to arise with ______ pathology
corneal
ciliary flush, presentation?
injection of the deep conjunctival vessels
- p/w uveitis, acute glaucoma, corneal inflammation, Not usually with conjunctivitis
Purulent/mucopurulent discharge suggests ______
bacterial conjunctivitis
copious purulent discharge, potentially blinding
GC
Serous discharge +/- preauricular node enlargement
suggests viral
keratic precipitates (KP) etiology
endothelial cellular deposits on the cornea -> uveitis
KP a/w _____
sarcoidosis
KP s/sx
diffuse haze or colored halos 2/2 corneal edema
- can have localized opacities 2/2 ulcer or keratitis
the depth of the anterior chamber is ___ w/acute angle glaucoma
shallow
Describe the pupil size for the following:
- uveitis
- acute glaucoma
- conjunctivitis
- small 2/2 spasm
- fixed mid-dilation
- pupil not affected
ddx for acute proptosis (forward displacement of the eye, like in graves)
- cavernous sinus disease
- orbital infection
ddx for chronic proptosis
- thyroid dz
- masses
episcleritis
inflammation of the superficial vessels of the sclera
scleritis
inflammation of the deep vessels of the sclera
why and how to distinguish episcleritis vs. scleritis
- 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
pterygium tx
surgical tx + anti-inflammatory eye drops
Corneal ulcer w/hypopyon (WBCs in anterior chamber)
possibly infection
requires heavy duty abx
hyphema
- def
- causes
- blood in the anterior chamber
- 2/2 DM, trauma
Must be worked up - look for perforation
Chalazion
- def
- management
- possible cause
- Cyst in the eyelid,
- Must drain, chronic, non-painful
- blepharitis can lead to this - must treat and clean eye lid
If pt has red eye but denies pain, halos, and photophobia, think ____
conjunctivitis
Why do you not want to prescribe topical anesthetics? When would you use them?
- they inhibit corneal healing, allergic rxns, and eliminate the protective blink reflex
- only use for dx (bc it inhibits the blink reflex)
what are the 4 risks of topical steroids?
- masks inflammation
- potentiates keratitis
- cataract formation
- elevated IOP
UNEQUAL PUPILS =
SERIOUS DISEASE
STAIN WITH ____
FLUORESCEIN
If visual acuity is reduced, _____ is unlikely
CONJUNCTIVITIS
Corneal edema (acute glaucoma), hyphema (trauma/ab vessels), cataracts, vitreous hemorrhage are all examples dzs w/ ______
media opacities
Think of ____ _____ when a patient has DM, SSA, retinal vein occlusion, SAH
vitreous hemorrhage
retinal ____ is an emergency
detachment
S/sx of retinal detachment/
- flashing lights (photopsia)
- floaters
- APD
Amaurosis fugax is a type of ___ dz, and the w/u includes ____ +_____
- retinal
- echo
- doppler
S/Sx of central retinal artery occlusion (CRAO)
EMERGENCY
- sudden
- painless
- severe vision loss
Retina appears _____ w/CRAO. The macula _____. The optic disc _____
- white
- cherry red spot
- does not usually swell
PE findings w/CRVO
- optic disc
- blood vessels
- retina
- disc swelling
- venous engorgement
- cotton wool spots
- flame hemorrhages
Giant cell arteritis tx
EMERGENCY
- high dose steroids
What are the different optic nerve diseases
- Giant cell
- optic neuritis
- papillitis
- papilledema
- ischemic optic neuropathy (altitudinal)
optic neuritis is ____ if it’s progressive
retrobulbar
papillitis causes
decreased vision
papilledema causes
no visual changes
Emergencies
D2GC retinal Detachment acute angle Glaucoma Giant cell arteritis CRAO Chemical burns
which chemical burns are more serious? Acidic or alkaline?
Alkaline
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
What type of fracture usually doesn’t cause loss of vision or ocular function?
orbial rim fracture
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
Medial (ethmoid) fractures s/sx
- crepitance
- subq edema of the lid
Fractures of optic canal cause
damage to optic nerve and vessels
Surgical repair required when what sx/conditions are present? (4)
- diplopia
- downward gaze
- endophthalmos
- large fracture
Refer a patient with lid lacerations if _____
it involves the lid margin or the lacrimal canalicula
If a pt has a hyphema always check for _______
perforation
Lens discoloration, iritis, vitreous hemorrhage, retinal hemorrhage/tears/detachment can all be sequelae of ________
blunt trauma
Actual or suspected penetrating trauma always requires ________
an eye shield!
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
Tx for superficial FB
0.5% proparacaine + wash
Tear drop pupil or flat anterior chamber –> suspect _____
perforation
____ is the most common cause of blindness in African Americans
glaucoma
No pain, nausea, halos, red eye, hazy cornea, fixed pupil, or acute vision loss refers to open or closed angle glaucoma?
open
A normal cup:disc ratio = ______
the ratio that should start raising concern = ___
- 3
0. 5
Normal IOP
<21
glaucoma is characterized by: - \_\_\_\_ IOP - cup:disc ratio of \_\_\_\_ - -
- increased
- > 0.5
- pallor
- asymmetric cup:disc ratio between eyes
Screening for glaucoma
q2-4y after 40
q3-5y from 20-39 in AAs
_____ is the most common cause of vision loss in the US
age related cataracts
When is surgery indicated for cataracts?
when it interferes with daily fxn
____ is the most common cause of irreversible central vision loss >52 yrs
age-related macular degeneration (MD)
Dry MD indicates_____ and represents ___% of cases
no choroid neovascularization
- 90%
_____ have been shown to reduce conversion between dry and wet MD
vitamins
wet MD indicates ______ and presents with _____
- chorioid neovascularization
- sudden vision loss
wet MD is treated with
Anti-VEGF injections
Leukocoria (white reflex) in a child has what DDx? (3)
- cataracts
- retinoblastoma
- primary hyperplastic vitreous (HPV)
What are the types of amblyopia (lazy eye)? (4)
- strabismic
- refractive
- form deprivation
- occlusive
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
amblyopia is treated with _____
an eye patch in early childhood
____ is the leading cause of blindness in working age Americans
Diabetes
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
What is an example of non-proliferative retinopathy in DM patients?
- macular edema, hard exudates, dot and blot hemorrhages
Severe non-proliferative retinopathy is characterized by ____ (3)
- increased tortuousity of blood vessels
- venous beading
- cotton wool spots
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
Whats the tx of proliferative retinopathy
laser to the retina
Buzzwords for AIDS
Cotton wool spots (2/2 microthrombi)
CMV retinitis
____ is the leading cause of visual loss in AIDS because it can cause ____ (3)
CMV retinitis
- retinal hemorrhages,
- white opacification
- floaters
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
keratitis and anterior uveitis are both _____
eye threatening lesions
How does HTN affect the eye?
- arteriolar sclerosis –> increase in the white reflex (copper wiring)
acutely elevated BP can cause ____ (4)
- fibrinoid necrosis of the vessel wall
- splinter hemorrhages
- exudates
- cotton wool spots
Malignant HTN can cuase
disc swelling
what effects does pregnancy have on the eye? (3)
- lower IOP
- transient loss of accommodation
- decreased corneal sensation
pregnant pts w/DM should see the ophthalmologist how frequently?
1x/trimester
Buzzword: hyperthyroidism (2)
corneal exposure, drying
Buzzword: sarcoid (5)
- anterior/posterior uveitis (tx w/steroids)
- optic neuropathy
- oculomotor problems
- dry eye (also in SLE, RA)
- FOCAL, NONCASEATING GRANULOMAS
cancer in the eye often comes from (4)
breast mets
lung mets
leukemia
lyphoma
Buzzword: syphilis
acute interstitial keratitis w/keratouveitis
What are the sx/sequelae of acute interstitial keratitis w/keratouveitis from syphilis?
- intense pain
- photophobia
- diffusely opaque cornea w/reduced vision
- late chorioretinitis
if someone presents with acute interstitial keratitis w/keratouveitis from syphilis what should you always do and why?
- Check CSF for neurosyphilis
how does candida infection of the eye present?
fluffy white superficial infiltrate, vitreous haze
how to treat candida in the eye?
amphotericin
