Ophthalmology Flashcards
Viral conjunctivitis
bilateral
watery discharge
easily transmissable
normal vision
itchy
preauricular adenopathy
no specific changes
bacterial conjunctivitis
unilateral
purulent, thick discharge
poorly transmissible
normal vision
not itchy
no adenopathy
topical antibiotics
the must know subjects in ophthalmology are
the red eye (emergencies)
diabetic retinopathy
artery and vein occlusion
retinal detachment
etiologies of the red eye
conjunctivitis
uveitis
glaucoma
abrasion
conjuctivitis
presentation-
eye findings -
most accurate test -
best initial therapy -
presentation- itchy eyes, discharge
eye findings - normal pupils
most accurate test - clinical diagnosis
best initial therapy - topical antibiotics
uveitis
presentation-
eye findings -
most accurate test -
best initial therapy -
presentation- autoimmune disease
eye findings - photophobia
most accurate test - slit lamp examination
best initial therapy - topical steroids
glaucoma
presentation-
eye findings -
most accurate test -
best initial therapy -
presentation- pain
eye findings - fixed midpoint pupil
most accurate test - tonometry
best initial therapy - acetazolamide, mannitol, pilocarpine, laser trabeculoplasty
abrasion
presentation-
eye findings -
most accurate test -
best initial therapy -
presentation - trauma
eye findings - feelsl ike sand in eyes
most accurate test - fluorescein stain
best initial therapy - no specific therapy, patch not clearly beneficial
chronic glaucoma
most often asymptomatic on presentation and is diagnosed by routine screening. confirmation is with tonometry indicating extremely elevated intraocular pressure, trat with medications to decrease the production of aqueous humor or to increase its drainage
glaucoma treatment
prostaglandin analogues: latanoprost, travoprost, bimatoprost
topical beta blockers: timolol, cateolol, metipranolol, betaxolol, or levobunolol
topical carbonic anhydrase inhibitiors: dorzolamide, brinzolamide,
alpha 2 agonists: apraclonidine
pilocarpine
laster trabculoplasty: performed if medical therapy is inadequate
acute angle closure glaucoma
look for sudden onset of an extremely painful, red eye that is hard to palpation. walking into a dark room can precipitate pain bc of pupillary dilation. the cornia is described as steamy and the pupil does not react to light bc it is stuck. the cup to disc ratio is greater than the normal 0.3, the diagnos is cofirmed with tonometry
treat acute angle closure glaucoma with
iv aceazolamid
iv mannitol to act as an osmotic draw of gluid aout of the eye
pilocarpine, bblockers, and apraclonidine to constrict the pupil and enhance drainage
laser iridotomy
herpes keratitis
infection of the cornea
the eye may be very red, swollen, and painful
do not use steroids
fluorescein staining of the eye helps confirm the dendritic pattern seen on examination
steroids markedly increase the production of the virus
herpes keratitis
treatment
oral acyclovir, famciclovir, or valacyclovir
topical antiherpetic treatment is trifluridine and idoxuridine
dont use what with herpes keratitis
steroids it makes it worse
cataracts
there is no medical therapy for cataracts
surgically remove the lens and replace with a new intraocular lens
the new lens may automatically have a bifocal capability
early cataracts are diagnosed with an ophthalmoscope or slit lamp exam
advanced cataracts are visible on examination
diabetic retinopathy
annual screening exams should detect retinopathy before serious visual loss has occurred.
nonproliferative or background retinopathy is managed by controlling glucose elvel.
the most accurate test is fluorescein angiography
proliferative retinopathy is treated with laser photocoagulation
vegf can be injected to control neovascularization
vitrectomy may be necessary to remove a vitreal hemorrahge obstructing vision
retinal artery and vein occlusion
both conditions present with the sudden onset of monocular vision loss
you cannot make the diagnosis wihtout retinal examination
there is no conclusive theraphy for either condition
treatment of retinal artery occlusion
100% o2, ocular massage, acetazolamide, or anterior chamber paracentesis to decrease intraocular pressure, and thrombolytics
treatment of retinal vein occlusion
ranibizumab
describe the macular in retinal artery occlusion
cherry red bc the rest of the retinal is pale
retinal detachment
etiology
tisks include tramua to the eye, extrmee myopia that changes the shape of the eye, and diabetic retinopathy. anything that pulls on the reina can detach it
retinal detachment
presentation
sudden onset of painless, unilateral loss of vision that is described as a curtain coming down
retinal detachment
reattachment
attempted with a number of mechanical methods such as surgery, laser, cryotherapy, and th einjection of an expansile gas that pushes the retina back up against the globe of the eyse.
