Ophthalmology Flashcards
Unilateral
Purulent, thick discharge
Poorly transmissible
Normal vision
Not itchy
No adenopathy
Bacterial conjunctivitis
Treat with topical abx
Bilateral
Water discharge
Easily transmissible
Normal vision
Itchy
Preauricular adenopathy
Viral conjunctivitis
The red eye (emergencies)
Diabetic retinopathy
Artery and vein occlusion
Retinal detachment
The “must know” subjects in ophthalmology
Red eye with:
Itchy eyes, discharge
Normal pupils
Conjunctivitis
Clinical diagnosis
Treat with topical abx
Red eye with:
Autoimmune diseases
Photophobia
Uveitis
Most accurate test = slit lamp exam
Treat with topical steroids
Red eye with:
Pain
Fixed midpoint pupil
Glaucoma
Most accurate test = tonometry (elevated pressure)
Treat with acetazolamide, mannitol, pilocarpine, and laser trabeculoplasty as a last resort
Red eye with:
Feels like sand in eyes
H/o trauma
Abrasion
Most accurate test = fluorescein stain
No specific therapy; patch not clearly beneficial
How does chronic glaucoma present?
Most often asymptomatic and is diagnosed on routine screening
Confirm with tonometry indicating extremely elevated intraocular pressure
Treatment for chronic glaucoma
Prostaglandin analogues: latanoprost, travoprost, bimatoprost
Topical beta blockers: timolol, carteolol, metipranolol, betaxolol, or levobunolol
Topical carbonic anhydrase inhibitors: dorzolamide, brinzolamide
Alpha-2 agonists: apraclonidine
Pilocarpine
Laser trabeculoplasty if medical therarpy is inadequate
Sudden onset of an extremely painful, red eye that is hard to palpation
Acute Angle-Closure Glaucoma
Walking into a dark room can precipitate pain (pupilary dilation); cornea is described as “steamy” and the pupil does not react to light because it is stuck; the cup-to-disc ratio is > 0.3
Treatment for acute angle-closure glaucoma
IV acetazolamide
IV mannitol (osmotic)
Pilocarpine, beta blockers, and apraclonidine (constric the pupil to enhance drainage)
Laser iridotomy
What is keratitis
Infection of the cornea
Testing and treatment for herpes keratitis
Confirm with fluorescein staining (dendritic pattern)
Treat with oral acyclovir, famciclovir, or valacyclovir
DO NOT use steroids because they markedly increase the production of the virus
Treatment for cataracts
Surgically remove the lens (no medical therapy)
Most accurate test for diabetic retinopathy
Fluorescein angiography
Treatment for diabetic retinopathy
Nonproliferative or “background” is managed by controlling glucose level
Proliferative retinopathy is treated with laser photocoagulation (VEGF inhibitors are injected in some patients to control neovascularization)
Sudden onset of monocular visual loss with a pale retina and dark macula (aka “cherry red” macula)
Retinal artery occlusion
Sudden onset of monocular visual loss with extravasation of blood into the retina
Retinal vein occlusion
Treatment of retinal artery vs retinal vein occlusion
Artery = 100% O2, ocular massage, acetazolamide, or anterior chamber paracentesis, and thrombolytics
Vein = ranibizumab (VEGF inhibitor)
Sudden onset of painless, unilateral loss of vision (“curtain coming down”)
Retinal detachment
Treament for retinal detachment
Mechanical methods (surgery, laser, cryotherapy, and injection of gas) to push the retina back up against the globe of the eye
Most common cause of blindness in older persons in the US
Macular degeneration
The cause is unknown; there is an atrophic (dry) and a neovascular (wet) type
Difference between wet and dry macular degeneration
Wet is more rapid/severe and causes 90% of cases of permanent blindness
Treatment for wet macular degeneration
VEGF inhibitor: ranibizumab, bevacizumab, or aflibercept
Injected directly into the viterous chamber every 4-8 weeks
Herpes zoster ophthalmicus
Dendriform corneal ulcers and a vesicular rash in the trigeminal distribution
