Ophthalmology Flashcards
retinal detachment
spontaneous high risk: post cataract- surgery "curtain's comes down and stays down" tx: refer all detachments positions head, allows gravity to slow the progression 80% get better
amaurosis fugal
curtains comes and goes back up in a few minutes
TIA, hx or risk of artheroscleroris
emboli on carotid circulation
tx: endarterectomy
retinal artery occasion
emboli comes into retinal after and does not pass and get ischemia most are embolic but can be thrombotic *painless sudden loss of vision signs: early--> distal to occlusion ( blood separation - box scarring) cherry red spot- more ischemia infraction tx: true emergency place pressure
retinal vein occlusion
older people with lots of plaque wake up in am and vision blurry exam: blood and thunder neovascularization tx: resolve on own laser tx
optic neuritis
inflammation of nerves
happens in chronic disease ( MS, autoimmune, infection)
exam: loss of pupillary reaction to light, loss of color vision, pain with EOM
tx: may resolve on own 2-3 wks
steroids, IV
glaucoma
increase in IOP with optic n damage
RF: AA, DM, HTN, Fam hx, Hx eye tumors, retinal detach
what is the pathophys of glaucoma?
resistance to drainage of aqueous humor–> pressure on posterior chamber–> pressure on optic nerve
Open angle glaucoma
asymptomatic, rise in IOP chamber is open bowing of iris on exam arcuate scotomata central vision spread tx: prostoglandin- promote drainage beta blockers carbonic any drate
tx: iridectomy
angle closure
OCULAR Emergency sudden complete occlusion pain, blurred vision n/v conjunctive injection, fixed mid-dilated pupil
tx: beta blocker
carbonic andydrate
mannitol
laser iridectomy
how to do glaucoma screening
check anterior chamber angle-
optic nerve exam- cup/disc ration: > 0.5
IOP> 21 mmHG
cataracts
product of age
acquired- sun exposure. inflamm, DM
congenital
macular degneration
Drusen- colloid bodies, deposit in Bruch’s membrane–> blocks nutrients in eyes
Dry AMD: only Drusen–> atrophy of retina, more common
Wet AMD–> neovascular, bleed a lot
sxs; blurry vision, central los of vision
sign: atrophy, loss of pigment, macular sccaring, bleeding
tx: laster photo
Lucentis is, Macugen
no cure
eye supplements
retinopathy
DM- T1DM- screen 3-5 years after dx T2DM- screen right away -3 types: Background: simple ( microaneuryms) pre-prolferat- cotton wool spots proliferative- neovascu HTNive: diffuse arteriolar narrowing, " copper wire" , " silver wire"
tx: rear, laser photocoag, tx underlying dz.
blepharitis
dandruff of eyelids staph or strep sx: irrigation, burning, FB sensation signs: anterior blepharitis tx: scrub daily, massage of sections, topical abs, oral abx oral abs- recurrent
dacryoscysitis
inflammation of lacrimal duct sxs; pain, swelling,tearing signs tx: warm to cool compressed oral abs I and D surgery- putting in tubes
hordeolum ( stye)
infection of sebaceous glands ( staph)
sxs: subacute onset, mild painful nodule or pustule on lid
signs: pointed, red, tender
tx: warm compress, topical ab ( fluroquino/ polymixin/ trimeth)
I and D
chalazion
occur post hordeolum painless signs: grayish discoloration local conjunctive erythema tx; warm compress triamcinolone injections cut it out
ectropion- lids turn outward
entropian- likes turn inward
causes: scarring of lid, related to age paralytic, mechanics
sx: irrigation, burning, FM sensation
tx: surgical correction
xanthelasma
idiopathic, hyper lip in DM
all cosmetic
excise
epithelial inclusion cyst
traumatic implantation of epidermis into dermis or plugged follicle
slow growing, white round firm
ddx: neoplasm
tx: excision
orbital cellulitis
more common in kids- 2nd to sinusitis low grade fever, fatigue, signs, red, sluggish pupillary reflex, cannot more their eyes tx: abs, IV then po 2-3 weeks need to do CT am-sublac, cephalon, monitor closely
viral conjunctivitis
adenovirus- most common acute onset- red, watery d/c peri-aurical adenopathy-tender self-limited cold-warm compressed
bacterial conjunctivitis
staph aureus, h. f.u. moraxella, pseudomonas ( contact)
- red, irritated, bila, mucopurulent exudate,
niseria- topical abs, systemic ( copious unlit)
tx: broad spectrum absx: fluoroquinolone, polymyxin, sulfa
chlamydial conjunctivitis
STI
scant mucopurulent d/c
non-tender periauricular adenoma, follicular response
tx; system tetra, topical abx
allergic conjunctivitis
seasonal
more edema
strongly mucoid d/c
tx: topical anti-histamin
Pinguecula
fleshy, yellow/brown conjunctival mass
- nasal side toward cornea
causes: chronic sun, trauma, dry/ windy conditions - no sxs, no tx
pterygium
triangular wedge- shaped fleshy
grown on the cornea–> vision issues
tx; remove by surgery
dry eye
idiopathic, aging, contact wears, RA, scleroderma, meds
clinical; irrigation, dryness, redness, FB
dx: artificial tears, ointment
punctual plug
Restates
herpes simplex kerastis
ocular EMERGENCY HSV 1>> HSV 2 very photophobic exam: dendritic lesions tx: REFER, topical anti-viral, No steroids
herpes zoster
HSV in the original nerve
clinical: pain, HA, photophobia, vesicular rash, lesions on tip of nose– ( on cornea)
tx: refer, IV valtrex, topica stenosi
prevention: Zosetavax > 50 y/o
cordial ulcer
infection/ inflamma h/o trauma, contact wearing - exam: pain, phothophbia, dense cordial infiltrate tx: REFER, scraping, Gram stain, tx causative agent, avoid contact use
corneal abrasion
cut to cornea
photophobia, blepharospasm, search for FB
tx: topical anesthetic at first only
cycloplegia, systemic analgesic
abx ointment, pressure patch ( max 24 hours)
f/u daily until gone
FB
cornea- more dangerous sxs: painful, tearing, exam: evert lid, fluroscene, tx: use forceps, needles, lead/rust- suspect laceration
subconunctival hemorrhage
after Valsalva
bening
resolves 2-3 weeks
orbital fx
trauma to a eye
trapped inferior rectus–> cannot look up
tx: CT scan, REFER
increase in IOP–>retinal detachment
no sneezing, blow your nose
hyphema
RBC in the anterior chambers associated with trauma call chile protection services shaken baby syndrome pain, blurry vision, neoplasm, tx: refer
radiant energy burn
6-12 hours pain the eye, red, tearing, photophobic
tx: cycloplegia, abx ointment,
pressure patch, systemic analgesic
wear sunglasses
lid laceration/
keep pt sill, avoid pressure
REFER- call surgeon
chemical burns
water, water,
cycloplegic
colon blindness
x linked - males
red, green
ishihara plates
amblyopia
loss of visual acuity not correctable by glasses
- due to mechanical issue
strabismus
angle/ degrees of misalignment is equal in all directions of gaze
- more congenial / genetic
- incomitant- degrees of misalignment differs with direct of gaze - due to neurologic disorder or trauma
strabismus test
cover/ uncover test:
heterotropia- cover normal eye, affected will move in place
heterophoria- cover suspected eye, uncover and misalignment may become apparent
tx: amblyopia: patch good eye
strabismus: glasses,
