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Neuro III > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Which bones make up the orbital floor?

A

PaM-Z: Palatine, Maxillary, Zygomatic

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2
Q

Which bones make up the medial wall of the orbit?

A

SMEL: Sphenoid (lesser wing), Maxillary, Ethmoid, Lacrimal

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3
Q

Which bones make up the orbital roof?

A

Frontal, Sphenoid (lesser wing)

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4
Q

Which bones make up the lateral wall of the orbit?

A

Sphenoid (greater wing) and zygomatic

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5
Q

Which area of the orbit is the weakest part?

A

orbital floor

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6
Q

Which area of the orbit is the thinnest?

A

Medial wall

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7
Q

Which muscles in the orbit are innervated by CN 3?

A

Superior branch: superior rectus muscle, levator muscle

Inferior branch: inferior rectus muscle, inferior oblique, medial rectus muscle

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8
Q

Which muscle is innervated by CN 4?

A

superior oblique

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9
Q

Which muscle is innervated by CN 6?

A

lateral rectus

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10
Q

Where is the infraorbital nerve?

A

Branch of Maxillary branch of trigeminal. Exits the skull through infraorbital foramen. Trauma –> cheek and upper lip hypesthesia

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11
Q

What are the two types of cellulitis involving the orbit?

A

Orbital cellulitis and preseptal cellulitis

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12
Q

Describe orbital cellulitis

A

Sub-periosteal abscess –> proptosis (eye pushed out)

Presents with pain, erythematous lid swelling, TTP, EOM restriction, proptosis

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13
Q

How is orbital cellulitis managed?

A

Broad spectrum antibiotics. Drain and incise abscess if present

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14
Q

What is a concerning sequelae of orbital cellulitis?

A

Cavernous sinus thrombosis. Can lead to stenosis of internal carotid artery

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15
Q

Describe preseptal cellulitis

A

Infection superficial to the septum. Able to open eye; no proptosis; no vision loss

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16
Q

How is preseptal cellulitis treated?

A

Drain pus

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17
Q

what is a chalazion?

A

Plugged Meibomian oil glands in the tarsus –> inflammation. Treatment = warm compress

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18
Q

What is the concern regarding an eyelid laceration that disturbs the septum?

A

Potential for disturbed levator aponeurosis –> ptosis

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19
Q

What is the algorithm for eyelid avulsion repair?

A

Reconnect levator aponeurosis to tarsus, reappose tarsus, reappose eyelid margins, reappose skin and orbicularis

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20
Q

What are the most common sites of orbital fracture?

A

floor and medial wall

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21
Q

What are indications for repair of fractured orbit?

A

Enophthalmos (eye sunken in), trapping of muscles/orbital tissues, fracture involving more than 50% of the wall

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22
Q

What is dacryocystitis?

A

Infection caused by obstructed nasolacrimal duct

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23
Q

How is dacryocystitis treated?

A

antibiotics to treat infection. Surgical bypass of the obstructed nasolacrimal duct

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24
Q

What is the most common malignant tumor of the lacrimal gland?

A

Adenoid cystic carcinoma

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25
Q

What is the treatment for adenoid cystic carcinoma?

A

radiation, chemo, exenteration (take out entire orbit)

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26
Q

What is the differential diagnosis of unilateral red eye?

A

Viral or bacterial conjunctivitis, iritis, corneal abrasion, corneal ulcer, herpes simplex, herpes zoster ophthalmicus, subconjunctival hemorrhage

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27
Q

What is the differential diagnosis for bilateral red eye?

A

Dry eyes, allergic conjunctivitis

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28
Q

What is the presentation of conjunctivits?

A

Pink eye, eye pain, discharge, blurred vision, mattering of eyelids in the morning

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29
Q

What is the most common type of conjunctivitis?

A

Viral (adenovirus) –> watery discharge

post-URI

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30
Q

Describe iritis

A

inflammation of the iris.

Ocular/periorbital pain, photophobia, blurred/cloudy vision, redness. May have irregularly shaped pupil

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31
Q

Iritis treatment

A

Topical steroid eyedrops, dilating eyedrops

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32
Q

What are the components of the basic eye exam?

A

visual acuity, visual field, ocular motility, pupils, external exam (eyelids, conjunctiva, cornea), fundoscopic exam (red reflex, disc, retina)

33
Q

What are possible implications of recurrent iritis?

A

ankylosing spondylitis, RA, Crohn’s, ulcerative colitis, Lupus, Sarcoidosis, Syphilis, TB

34
Q

How does corneal abrasion present on exam?

A

possible presence of irregular epithelium and slightly cloudy cornea.

35
Q

What is associated with contact lens use?

A

corneal ulcer (bacterial or protozoan). Risk = 10x higher for extended wear

36
Q

What is a distinct characteristic of corneal ulcer?

A

White infiltrate in the cornea

37
Q

What are common foreign bodies found in the cornea?

A

metal, glass, organic material

38
Q

Describe herpetic keratitis

A

eye redness, pain, photophobia, decreased vision, and tearing.

Fluorescein on the ocular surface –> dendritic epithelial ulcer with branching pattern and terminal bulbs

39
Q

Treatment of herpetic keratitis

A

watchful waiting (usually resolves in 3 weeks) or oral acyclovir/valacyclovir

40
Q

What is the etiology of herpes zoster ophthalmicus?

A

reactivation of VZV. V1 dermatological involvement

41
Q

How does herpes zoster ophthalmicus present?

A

prodromal fatigue; low-grade fever; unilateral rash on forehead, upper eyelid, and nose; unilateral eye pain, redness; decreased vision; photophobia

42
Q

What are the risk factors for angle closure glaucoma?

A

Asian, geriatric, hyperopia

43
Q

How does angle closure glaucoma present on exam?

A

sluggish mid-dilated pupil, conjunctival injection, hazy cornea and shallow anterior chamber

44
Q

What is open angle glaucoma?

A

progressive disease of the optic nerve associated with elevated intraocular pressure. No symptoms

45
Q

What are common symptoms of cataract development?

A

vision appears as though looking through a dirty window, color desaturation, night-time glare, halos

46
Q

What are the indications for cataract surgery?

A

vision cannot be corrected with glasses, cataracts interfering with daily activities

47
Q

dark red spot with visible overlying vasculature on fundoscopic exam

A

Subretinal hemorrhage

48
Q

Dot-blot hemorrhage on fundoscopic exam

49
Q

Flame/splinter hemorrhage on fundoscopic exam

A

hypertension

50
Q

Vitreous hemorrhage (obscured retina) on fundoscopic exam

51
Q

Hard, yellow exudate on fundoscopic exam

52
Q

Drusen (yellow subretinal deposits in macula) on fundoscopic exam

A

hallmark of macular degeneration

53
Q

Hollenhorst plaque in arteriole bifurcation on fundoscopic exam

A

embolus from carotid atherosclerotic plaque

54
Q

Cotton wool spots on fundoscopic exam

A

diabetes, hypertension

55
Q

Choroidal nevus on fundoscopic exam

A

benign pigmented neoplasm

56
Q

Macular scar on fundoscopic exam

A

old inflammation

57
Q

What is the number 1 cause of blindness in working age adults?

A

diabetic retinopathy

58
Q

Pathophysiology of diabetic retinopathy

A

microvascular injury –> retinal hemorrhage –> capillary leakage –> ischemia –> neovascularization

59
Q

What is the more severe form of diabetic retinopathy

A

proliferative = vision threatening

60
Q

What is the number one cause of vision loss in DM?

A

diabetic macular edema (non-proliferatic diabetic retinopathy)

61
Q

How is diabetic retinopathy managed?

A

glycemic control, BP control, laser photocoagulation, Anti-VEGF injection, pars plana vitrectomy (tractional retinal detachment)

62
Q

Characteristic hypertensive retinopathy findings

A

vasoconstriction, Arteriosclerosis (copper and silver wiring, aterio-venous nicking)

63
Q

central retinal vein occlusion findings

A

dilated veins and extensive hemorrhage

64
Q

central retinal artery occlusion findings

A

“stroke” to the eye. cherry red spot

65
Q

what is the number one cause of blindness in people age 50+?

A

age-related macular degeneration

66
Q

what are age-related macular degeneration risk factors?

A

> 75y, white, female smokers

67
Q

What is the number one optic neuropathy?

A

glaucoma (nerve fiber layer and optic disc injury –> visual field loss)

68
Q

glaucoma risk factors

A

age, elevated IOP, race, central corneal thickness, family hx, myopia

69
Q

Papilledema

A

increased intracranial pressure –> bilateral optic disc swelling

70
Q

Fundoscopic findings associated with papilledema

A

blurred disc margin (sometimes with surrounding hemorrhage)

71
Q

What are the two types of anisocoria?

A

abnormal miosis, abnormal mydriasis

72
Q

Describe abnormal miosis

A

Horner syndrome: sympathetic dysfunction –> poor “dark” response –> dilation lag, ptosis +/- anhidrosis

73
Q

Mydriatic pupil with poor light response

A

abnormal structure = iris damage

Parasympathetic dysfunction –> Tonic pupil (tonic dilation, segmental palsy, light-near dissociation), CN3 palsy (ptosis, EOM paresis)

74
Q

Pathway of neurologic pathway disturbances

A

optic nerve –> optic chiasm –> optic tract –> lateral geniculate nucleus –> optic radiations –> occipital cortex

75
Q

Hallmarks of visual field loss from neurologic visual pathway disturbances

A

defect respects vertical and/or horizontal meridians
defect is homonymous (same area of visual field in each eye)
defect is a combination of homonymous + respects vertical median

76
Q

Clinical features of optic neuritis

A

visual acuity loss, central visual field loss, pain with eye movements, younger patients, usually normal optic disc at onset, recovery by 6-10wks

77
Q

Clinical features of anterior ischemic optic neuropathy (AION)

A

+/- Visual acuity loss, altitudinal/arcuate VF loss, older patients, edematous and hemorrhagic optic nerve, minimal recovery

78
Q

clinical approach to complaints of diplopia

A

Is it binocular? (yes = ocular misalignment)
Horizontal or vertical?
Worse with any position of gaze?
worse at near or distance viewing?

79
Q

Most common cause of oscillopsia

Neuro III (17 decks)

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