Ophthalmology

Question 1

Blepharitis w/ intense itching, rubbing, rash or contact sensitivity; allergic rxn. Margins of eyelids are edematous and erythematous

Answer 1

Acute nonulcerative

Question 2

Blepharitis that is crusty

Answer 2

Acute ulcerative: bacterial

Question 3

Cause of spots or floaters

Answer 3

Benign vitreous opacities, posterior vitreous detachment w/risk of retinal damage, vitreous hemorrhage or posterior uveitis.

Question 4

Diplopia

Answer 4

Double vision

Question 5

Cause of Diplopia

Answer 5

Ocular misalignment: eye movement disorders (muscles) or cranial nerve palsies, orbital disease, orbital fracture.
Monocular diplopia- refractive error or lens opacities

Question 6

Leading cause of blindness or vision loss

Answer 6

• Cataract
• Uncorrected refractive error
• Age related macular degeneration

Question 7

Sx of Hordeolum

Answer 7

Redness of eyelid, swelling, pain, tearing, photophobia, foreign body

Question 8

Types of Hordeolum

Answer 8

External; of the hair follicles

internal; of the meibomian gland

Question 9

Pathophysiology of Hordeolum

Answer 9

Blocked sebaceous glands

Question 10

Tx of Hordeolum

Answer 10

Warm compress for 5-10 min, 3-4 times daily. Drainage or Rx if does not respond to Tx

Question 11

Difference between Hordeolum and Chalazion

Answer 11

Hordeolum: usually involves lashes and is painful
Chalazion: involves meibomian gland on lid, painless

Question 12

What is a noninfectious obstruction of the meibomian gland?

Answer 12

Chalazion

Question 13

Pathophysiology of Chalazion

Answer 13

Meibomian gland becomes blocked. Often chronic, usually painless, can follow internal hordeolum. Can be

Question 14

Inflammation of the eyelid margins

Answer 14

Blepharitis: acute or chronic

Question 15

Types of Blepharitis

Answer 15

Acute ulcerative (bacterial or virus), acute non ulcerative, chronic

Question 16

Acute ulcerative: bacterial

Answer 16

Usually staphylococcal, affects eyelid margins at origins of lashes.

Question 17

Chronic Blepharitis

Answer 17

Non-infectious inflammation of unknown cause. Often seen in patients with Rosacea , reoccurring hordeola or chalazia.

Question 18

Itching and burning of eyelid margins, conjunctival irritation w/ lacrimation, photosensitivity, foreign body sensation. Dilated glands that may exude waxy, yellowish secretions. Can have greasy, but easily removed scales of eyelid margins.

Answer 18

Sx of Blepharitis

Question 19

Dx of Blepharitis

Answer 19

Slit lamp exam

Question 20

Tx of Blepharitis

Answer 20

Warm compress, cleaning w/ baby shampoo, gentle removal of scales.
Acute: antibiotic ointment

Question 21

Causes of eye redness

Answer 21

• Hyperemia (excess of blood in vessels) of conjunctiva, ciliary, episcleral vessels
• Erythema of eyelids
• Subconjunctival hemorrhage

Question 22

Causes of eye pain

Answer 22

• Trauma
• Infection
• Inflammation
• Increase in IOP

Question 23

Causes of feeling of foreign body in eye

Answer 23

• Foreign body
• Eyelashes rubbing (trichiasis)
• Disturbance of corneal epithelium

Question 24

Causes of photophobia

Answer 24

Usually: corneal inflammation or anterior uveitis
Rarely: albinism, aniridia, cone dystrophy, or fever associated with various systemic infections.

Question 25

Causes of eye itching

Answer 25

Allergic eye disease

Question 26

Causes of eye scratching or burning

Answer 26

- Lacrimal gland hypofunction, secondary to systemic disorders (eg, Sjögren disease) - Drugs (eg, atropine-like agents) - Ocular surface disease - Dry environment.

Question 27

Causes of eye watering

Answer 27

Inadequate tear drainage due to: - obstruction of the lacrimal drainage system - malposition of the lower lid Disturbance or corneal epithelium will cause reflex tearing

Question 28

Causes of "eyestrain" & headache

Answer 28

``` Refractive error: - presbyopia - inadequate illumination - latent ocular deviation Giant cell arteritis Acute angle closure glaucoma ```

Question 29

Causes of conjunctival discharge

Answer 29

Bacterial infection of the conjunctiva, cornea, or lacrimal sac

Question 30

Causes of visual loss | reduced visual acuity

Answer 30

``` Refractive error, corneal opacities, cataract, intraocular inflammation (uveitis), vitreous hemorrhage, retinal detachment involving the macula, diabetic retinopathy, central retinal vein occlusion, central retinal artery occlusion, macular degeneration, optic nerve disorders. ```

Question 31

Cause of monocular visual loss

Answer 31

Disease of the retina or optic nerve

Question 32

Better eye less than 20/60 but 20/400 or better

Answer 32

Low vision

Question 33

Best corrected distant visual acuity in the better eye of less than 20/400 or widest diameter of the visual field of an angle less than 20 degrees

Answer 33

Blindness

Question 34

Emergent vs urgent referring for diplopia

Answer 34

Emergent: recent onset isolated third nerve palsy, particularly if there is pupillary involvement or pain. (inter cranial aneurysm) Urgent: any other recent onset of diplopia Admit emergently: Giant cell arteritis

Question 35

Causes of "Spots Before the Eyes" & "Flashing Lights"

Answer 35

Commonly benign vitreous opacities. Together with flashing lights: refer urgently for possible retinal tear or detachment

Question 36

Causes of a large, poorly reacting pupil

Answer 36

- Third nerve palsy - Iris damage caused by acute glaucoma - Acute tonic pupil (autonomic nervous sys disorder) - Rx

Question 37

Causes of a small pupil

Answer 37

- Horner syndrome - inflammatory adhesions between iris and lens - long-standing tonic pupil - neurosyphilis (Argyll Robertson pupils)

Question 38

Causes of pupillary light reaction

Answer 38

Optic nerve disease

Question 39

When to refer to Ophthalmology emergently

Answer 39

Sudden vision loss due to: - giant cell arteritis - acute glaucoma - corneal ulcer - acute anterior uveitis - orbital cellulitis - gonococcal keratoconjunctivitis - ocular trauma - contact lens wearer with acute, painful red eye- bacterial keratitis

Question 40

When to refer to Ophthalmology urgently

Answer 40

- Acute anterior uveitis | - Gradual loss of vision

Question 41

Refractive errors

Answer 41

Myopia Hyperopia Presbyopia Astigmatism

Question 42

Farsightedness, eye too short and focus in behind retina

Answer 42

Hyperopia

Question 43

Nearsightedness, eye too long and focus anterior to retina

Answer 43

Myopia

Question 44

Uneven curvature of the cornea

Answer 44

Astigmatism

Question 45

Presbyopia

Answer 45

Gradual loss of accommodation with age. Usually start to notice inability to focus at normal reading distance around age 45

Question 46

Treatment for refractive errors

Answer 46

- Glasses/contacts lens - Surgery - Rx, rigid contacts worn at night, or soft lenses may reduce rate of progression

Question 47

Risks for contact lens use

Answer 47

bacterial, amebic, or fungal corneal infection

Question 48

Infection of the lacrimal sac

Answer 48

Dacryocystitis

Question 49

Most common cause of viral conjunctivitis

Answer 49

Adenovirus

Question 50

Rx to treat inflammation

Answer 50

Steroid