ophthalmology Flashcards
myopia
light focuses in front of the retina
hyperopia
light focused behind the retina
astigmatism
asymmetry of the corneal surface, blurred vision
strabismus
deviation of one eye; double vision, progressive blindness in one eye as the brain ignores one eye (ambylopia)
Ambylopia
brain stops processing visual information from one eye
developmental defect
most common cause if strabismus
Treat with vision training- patch the good yee
MCC blindness >55yo
macular degeneration
MCC blindness
DM
MCC blindness in anyone black
glaucoma
Conjunctiitis most common viral cause
MCC viral- adenovirus
bacterial conjunctivitis
s. aureus, s. pneumonia, n. gonorrheae, chlamydia trachomitis
Most likely cause of conjunctivitis appearing in the first 24 hours of life?
chemical conjunctivitis resulting from antibiotic eye drops newborns receive
uveitis
inflammation of iris, ciliary bodies, and/or choroid
may be anterior or posterior
Anterior: pain and redness of iris, photophobia
Posterior: mild vision abnormalities. CMV, toxoplasma, cat scratch disease
may be 2/2 infection, or autoimmune, or rheumatic disease PAIR psoriatic arthritis ankylosing spondylitis IBD-related arthritis Reactive arthritis
kawasaki disease
red eye and corneal ulceration
herpes simplex keratitis
red eyes and collagen- vascular disorder
uveitis or scleritis
red eyes and colored halos
acute angle- closure glaucoma
red eyes and itchiness
allergic conjunctivitis
red eyes and preauricular lymph node enlargement
viral conjunctivitis
red eyes that are dry
keratoconjunctivitis sicca (complication of SJS)
red eyes and shallow anterior chamber
acute angle- closure glaucoma
orbital versus periorbial cellulitis
orbital cellulitis is more severe than periorbital cellulitis, involving more than just the skin. Neither involves the eyeball
orbital cellulitis: proptosis contents of orbit involved pain with eye movement weakness or paralysis of EOMs (ophthalmoplegia) impaired vision
can be deadly
Inflammatory conditions of the eyelids:
chalazion
inflammation of internal Meibomian sebacious glands (eyelid swelling), deep in the eyelid
treat- usually self- limiting, but can be surgically excised, or intralesional steroid injection
Inflammatory conditions of the eyelids:
hordeolum
infection of external sebaceous glands of Zeiss or Mol (tender, red swelling at lid MARGIN)
Treat with hot compress 3-4 times per day for 10-15 minutes, if unresolved in 48 hours, then I&D, +/- antibiotic ointment q3 hours
Inflammatory conditions of the eyelids:
anterior blepharitis
infection of eyelids and lashes secondary to seborrhea (red, swollen, lid margins + dandruff on lashes)
Wash lid margins daily with shampoo, remove scales daily with cotton ball, antibiotic ointment daily to lid margins
how do you treat acute angle- closure glaucoma?
the angle closes between the iris and sclera, closing off canal of schlemm to anterior fluid, fixed mid- dilated pupil, rock hard eyeball
pressure- lowering eye drop regimen: 1 drop each eye, one minute apart of 0.5% timolol, 1% apraclonidine, 2% pilocarpine
acetazolamide 250mcg 2 tabs once
IV mannitol in refractory cases confirmed by an opthalmologist
you want to get the patient to an ophthalmologist within an hour for laser iridotomy
open angle glaucoma treatment
trabecular meshwork is clogged up for reasons not having to do with angle
more gradual and common than acute. often bilateral unlike acute. increased cup to disk ratio to >50%, or tonometry
Treat with latanaprost (prostaglandins increase outflow of aqueous humor)
topical beta blockers (inhibits production of aqueous humor)
alpha2 adrenergic agonists decrease beta- adrenergic stimulation, decrease production of aqueous humor, increase outflow of aqueous humor
cholinergic agonists (pilocarpine), constricts the pupil, thereby opening up the trabecular meshwork
carbonic anhydrase inhibitors (Acetazolamide), which prevents production of humor.
lasers can be used to drill holes in the meshwork
macular degeneration
the macula is a spot on the retina that is packed with cone cells that provide fine central vision
without the macula, peripheral vision is intact
dry (Atrophic, drusen accumulates on retina, gradual loss of vision) and wet (sudden onset with rapid progression and neovascularization)
slit lamp exam for dry
fluorescein angiogram for wet
treatment: stop smoking anti-vegf into vitreous humor antioxidants (zinc, vit C, vit E) \+/- intravitreal ranizumab injection
retinal detachment
painless sudden loss of vision
sudden onset of flashing lights and floaters
reduction in vision
treatment:
laser photocoagulation
cryotherapy
surgical reattachment of the retina
central retinal artery occlusion
sudden painless vision loss, vision suddenly gone, dramatic
pale retina with a cherry red spot on the macula (blood vessels behind this spot are visible)
treat: throbolytics, acetazolamide, mannitol, stick a needle in the eye to reduce intraocular pressure to improve perfusion, give oxygen
retinal hemorrhage
dilated veins, cotton wool spots
Tx: VEGF inhibitors
Corneal abrasion treatment
thorough eye exam with removal of foreign body by irrigation
topical antibiotics QID continued 3-5 days or until the eye is symptom- free for 24 hours (ointment>drops)- erythromycin, sulfacetamide, ciprofloxacin, ofloxacin
OTC lubricant (refresh PM, lacri-lube) as needed up to hourly
pressure patching is optional for the first 24 hours, and is contraindicated if a foreign body is present. no role for pirate patch
pain control with systemic opioids, or ophthalmic NSAIDs (diclofenac, ketorolac)
do not prescribe topical anesthetic or topical steroids
