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Fundamentals of Medicine: EENT > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What is a hordeolum?

A

localized infection or inflammation of the eyelid margin involving hair follicles of the eyelashes

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2
Q

What is an internal hordeolum compared to an external hordeolum?

A

An internal hordeolum is a meibomiam gland abscess that points towards the conjunctiival surface/presents on the inside of the eyelid. An external hordeolum or sty is a smaller abscess on the margin of the eyelid.

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3
Q

What is the pathophysiology/ most common cause of hordeola?

A

Hordeolum’s are common staphylococcal abscesses. Most commonly Staph aureus.

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4
Q

Which age group does hordeola most commonly affect?

A

Children and teens

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5
Q

What are common symptoms of Hordeola?

A 
eyelid redness
tearing
swelling
pain
photophobia
foreign body sensation
vision acuity is normal
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6
Q

If left untreated, or does not respond to treatment, what general illness can hordeola lead to?

A

general cellulitis of the lid

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7
Q

In what situation are hordeola diagnosed, and what might it be hard to distinguish from?

A

Hordeola are diagnosed in the clinic, but can be difficult to distinguish from chalazion.

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8
Q

How is a hordeolum treated?

A

warm compresses are helpful (5-10 minutes, 3-4 times a day)
incision, if a resolution does not begin within 48 hours
applying antibiotic ointment may be beneficial every 3 hours in the acute stage

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9
Q

What is a chalazion?

A

a noninfectious obstruction of the meibomiam gland; a common granulomatous inflammation of a Meibomian gland that may follow an internal hordeolum

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10
Q

What are granulomas?

A

a collection of immune cells that form when the immune system attemps to wall off substances it perceives to be foreign, but cannot eliminate

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11
Q

What is the cause of Chalazia?

A

The meibomian gland becomes blocked by accumulation of secretion, often in a patient with blepharitis; blocked meibomian gland’s duct releases gland contents into soft tissue of the eyelid, causing a build-up under the eyelid

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12
Q

What other lid disorders can contribute to Chalazia?

A

hordeola and blepharitis

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13
Q

Chalazia are common among patients with what other type of conditions?

A

Chalazia are commonly found in patients with other skin conditions

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14
Q

What are common symptoms of Chalazion?

A

eyelid redness
nontender swelling on the lid
swelling of the adjacent conjunctiva
may distort vision, if the swelling is large enough to impress the cornea

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15
Q

How would you treat Chalazion?

A

warm compresses are helpful (5-10 minutes, 3-4 times a day)
incision and curettage, if chalazion persists past several weeks
corticosteroid injection may also be effective (reduces inflammation)

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16
Q

How do you distinguish between chalazion and hordeolum?

A

After a few days, chalazion will be nontender, and localization will occur away from the lid margin. Whereas, hordeolum will remain painful and present on the lid margin near the eyelashes. Hordeolum are also infectious, whereas chalazion are not.

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17
Q

What is Blepharitis?

A

inflammation of the eyelid margins that may be acute or chronic

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18
Q

List 5 ways that Blepharitis can be characterized.

A
  1. Acute Ulcerative
  2. Acute Non-Ulcerative
  3. Chronic
  4. Anterior
  5. Posterior
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19
Q

What is the cause of Acute Ulcerative Blepharitis?

A

caused by a bacterial infection; usually staphylococcal

may also be caused by a virus (herpes simplex, varicella zoster)

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20
Q

What is the cause of Acute Nonulcerative Blepharitis?

A

caused by an allergic reaction

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21
Q

What area of the eye does Acute Blepharitis affect?

A

the eyelid margin at origins of the eyelashes

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22
Q

What is the difference between eye discharge caused by a bacterial infection and discharge caused by a viral infection?

A

Bacterial infections cause crusty looking, pussy discharge. Viral infections cause watery, wet discharge.

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23
Q

What is the cause of Chronic Blepharitis?

A

we don’t know; chronic blepharitis is ideopathic noninfectious
inflammation

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24
Q

What does seborrheic mean?

A

common red, itchy skin rash

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25
Q

What other conditions do patients with Chronic Blepharitis commonly have?

A

acne rosacea
recurrent hordeola or chalazia
seborrheic dermatitis of face and scalp
increased tear evaporation and secondary keratoconjunctivities (especially those with meibomian gland dysfunction or seborrheic blepharitis)

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26
Q

What are common symptoms of Acute Ulcerative Blepharitis?

A

small pustules may develop on the eyelash follicles
may form shallow marginal ulcers
eyelids can become glued together by dried secretions
red eyelid margins

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27
Q

What are common symptoms of Acute Non-ulcerative Blepharitis?

A 
eyelid margins have excess fluid
eyelid redness
eyelashes can become crusted
itching
rubbing and rash
contact sensitivity
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28
Q

What are common symptoms of Chronic Blepharitis?

A

itching and burning of the eyelid margins
conjunctival irritation
tearing
photosensitivity
foreign body sensation
greasy and scales in seborrheic blepharitis

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29
Q

What exam technique is used to diagnose blepharitis?

A

Slit-Lamp Exam

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30
Q

What are common supportive treatment measures for blepharitis?

A

treatment of keratoconjunctivitis sicca (dry eyes)
warm compresses
cleansing of the eyelids with eyelid cleanser or baby shampoo

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31
Q

What is a form of treatment used for Acute Nonulcerative Blepharitis?

A

if persistent, topical corticosteroids for inflammation

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32
Q

What is a form of treatment for bacterial-caused Acute Ulcerative Blepharitis?

A

antimicrobials

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33
Q

Is Blepharitis commonly bilateral or unilateral?

A

bilateral

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34
Q

What area of the lid does Anterior Blepharitis affect?

A

involves eyelid skin, eyelashes, and associated glands

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35
Q

What area does Posterior Blepharitis affect

A

meibomiam glands

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36
Q

What conditions are associated with Anterior Blepharities?

A

staphylocci infection
seborrheic dermatitis
seborrhea of scalp, brows, and ears

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37
Q

What condition is Posterior Blepharitis strongly associated with?

A

acne rosacea

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38
Q

What are common symptoms of Anterior Blepharitis?

A 
irritation
burning
itching
red-rimmed
scales or granulations clinging to the lashes
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39
Q

How is Anterior Blepharitis treated?

A

cleanliness of the lid margins
daily removal of scales or ganulations on eyelashes
antibiotic ointments may be applied to lid margins

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40
Q

What are symptoms of Posterior Blepharitis?

A 
irritation
burning
itching
lid margins are hyperemic (red, excess of blood) with telangiectasias (spider veins)
meibomiam glands are inflamed
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41
Q

What are telangiectasisas?

A

spider veins

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42
Q

How is Posterior Blepharitis commonly treated?

A

gland expression may be sufficient

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43
Q

If Posterior Blepharitis causes inflammation of the conjunctiva, what are more active treatments that can be used?

A

long-term low-dose oral antibiotic therapy (kills staphylococci)
short-term topical corticosteroids (reduce inflammation)

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44
Q

What is Entropian?

A

the inward turning of the lower lid

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45
Q

What causes Entropian?

A

age-related tissue relaxation (due to weakness of the muscle surrounding the eye or as a result of degeneration of the fascia)
may follow scarring of the conjunctiva
post infectious or post traumatic changes
blepharospasm

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46
Q

What are symptoms of Entropian?

A 
occurs gradually over time
foreign body sensation
tearing
red eye
may cause redness, light sensitivity, dryness, or scratching of the cornea by the lashes and subsequent irritation
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47
Q

In what population does entropian primarily occur?

A

elderly

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48
Q

How is entropian diagnosed?

A

in clinical examination

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49
Q

How is Entropian treated?

A

surgery if the lashes rub on the cornea
botulinum toxin (temporary)
epilation of the eyelashes
cool compresses to reduce swelling

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50
Q

What is Ectropian?

A

the outward turning of the lower lid

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51
Q

What can cause Ectropian?

A

age-related tissue relaxation
cranial nerve VII palsy
post-traumatic or post-surgical changes

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52
Q

What are symptoms of Ectropian?

A 
excessive tearing
dry eyes
exposure keratitis
redness
light sensitivity
foreign body sensation
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53
Q

In what setting is Ectropian diagnosed?

A

in clinical examination

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54
Q

How is Ectropian treated?

A

symptomatic relief includes tear supplements and lubricants

surgery if there is excessive tearing, exposure keratitis, or a cosmetic problem

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55
Q

What is Dacryocystitis?

A

an infection of the lacrimal sac usually due to congenital or acquired obstruction of the nasolacrimal system

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56
Q

What are the two types of Dacryocystitis, and what causes them?

A

Dacryocystitis can be acute or chronic. Acute Dacryocystitis is usually caused by straph aureus or streptococci. Chronic Dacryocystitis can by caused by Staph epidermis, streptococci, or gram-negative bacilli

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57
Q

What age groups most often have Dacryocystitis?

A

infants

adults over 40

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58
Q

Is Dacryocystitis usually bilateral or unilateral?

A

unilateral

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59
Q

What are common symptoms of Acute Dacryocystitis?

A 
pain
swelling
tenderness
redness
purulent, pussy material may be expressed
all in the tear sac area
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60
Q

What are common symptoms of Chronic Dacryocystitis?

A

tearing and discharge

mucus or pus may be expressed

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61
Q

How is Acute Dacryocytitis treated?

A

warm compresses
systemic antibiotic therapy
surgery of the underlying obstruction may be done electively, but is sometimes performed urgently in acute cases

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62
Q

How is Chronic Dacryocystitis treated?

A

antibiotics may give temporary relief, but surgical correction is needed
common and often resolves spontaneously; sometimes duct massage is helpful with large swellings

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63
Q

What is Conjunctivitis?

A

inflammation of the conjunctiva

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64
Q

What is the most common eye disease?

A

conjunctivitis

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65
Q

What are most cases of Conjunctivitis caused by?

A

Viruses or bacterial infections, including gonoccal and chlamydial

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66
Q

What are causes of Conjuntivitis?

A 
viral and bacterial infection
keratoconjunctivitis sicca *dry eye
allergy
chemical irritants
self-harm
contact with a contaminated object or surface
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67
Q

How can conjunctivitis be transmitted?

A

Conjunctivitis is very contagious. IT can be transmitted directly by contact with contaminated fingers, towels, hankerchiefs, etc. Even contaminated eyedrops

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68
Q

How is Viral Conjunctivitis transmitted?

A

adenovirus is the most common cause of viral conjunctivitis

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69
Q

What are symptoms of Viral Conjunctivitis?

A

cold symptoms (malaise, fever, pharyngitis, preauricular adenopathy)
burning or gritty sensation
eyelashes may stick together
copious watery discharge (common with viruses!)
foreign body sensation
follicular conjunctivitis

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70
Q

How is Viral Conjunctivitis treated?

A

There is no specific treatment for viral conjunctivitis. It usually lasts two weeks and goes away on its own. Cold compresses can be sued to reduce discomfort. Topical sulfonamides (oral antibiotics) can be used to prevent a secondary bacterial infection.

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71
Q

Is Viral Conjunctivitis usually bilateral or unilateral?

A

Bilateral; if unilateral, it is typically caused by the Herpes Simplex Virus and is associated with lid vesicles. HSV conjunctivitis is typically treated with topical and/ or systemic antivirals.

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72
Q

What are common causes of Bacterial Conjunctivitis?

A

Chlamydiae, gonococci, S. aureus, Streptococci pneumoniae, Pseudomonas, Haemophilus species, Moraxella

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73
Q

What are common symptoms of Bacterial Conjunctivitis?

A

pussy discharge (common with bacterial infections!)
mild discomfort
eyelashes stick together

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74
Q

What important symptom does Conjunctivitis NOT cause?

A

Bacterial conjunctivitis does NOT cause blurred vision

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75
Q

How is Bacterial Conjunctivitis diagnosed?

A

in clinical examination

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76
Q

What studies might be ordered in the diagnosis of Bacterial Conjunctivitis?

A

scrapings and cultures in severe cases

other STD testing in the chlamydia and gonorrhea cases

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77
Q

How is Bacterial Conjunctivitis treated?

A

with a topical sulfonamide or oral antibiotic

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78
Q

When should you refer Bacterial Conjunctivitis to an ophthalmologist?

A

If symptoms do not relieve after 48-72 hours after treatment
If Gonococcal Conjunctivitis is present
When there is corneal involvement

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79
Q

How is Gonococcal Conjunctivitis typically acquired?

A

through contact with infected genital secretions (TEST FOR OTHER STDs)

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80
Q

What is the trademark symptom for Gonococcal Conjunctivitis?

A

copious purulent discharge

also redness, lid edema, and tenderness upon palpation

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81
Q

How can you test for Gonococcal Conjunctivitis?

A

scraping or culture of discharge

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82
Q

When should you refer Gonococcal Conjunctivitis?

A

ALWAYS, EMERGENTLY

Gonococcal Conjunctivitis may lead to perforation of the cornea

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83
Q

How is Gonococcal Conjunctivitis treated?

A

1-g dose of intramuscular ceftriaxone

topical antibiotics may be added

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84
Q

What else is recommended upon suspicion of Gonococcal Conjunctivitis?

A

screening for other sexually transmitted diseases

routine treatment for chlamydial infection

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85
Q

Chlamydial Keratoconjunctivitis is the most common cause of what?

A

blindness worldwide

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86
Q

What is another name for Chlamydial Keratoconjunctivitis?

A

Trachoma

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87
Q

How is Chlamydial Keratoconjunctivitis diagnosed?

A

immunologic tests or polymerase chain reaction on conjunctival samples, but do not wait to treat

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88
Q

What might Chlamydial Keratoconjunctivitis lead to?

A

scarring of the tarsal conjunctiva leads to entropion adn trichiasis, inversion of the eyelashes, in adulthood

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89
Q

How is Chlamydial Keratoconjunctivitis treated?

A

1-g dose of azithromycin

improvements in hygiene can assist with prevention

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90
Q

What is Allergic Conjunctivitis?

A

acute, intermittent, or chronic conjunctival inflammation usually caused by airborne allergens (pollens, molds, dust mites, animal dander)

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91
Q

What are symptoms of Allergic Conjunctivitis?

A 
redness
stringy, watery discharge/tearing
intense itching
conjunctival edema and/or hyperemia
eyelashes stick together
burning sensation
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92
Q

What is Vernal Keratoconjunctivitis?

A

severe type of conjunctivitis common among males aged 5-20 with eczema, asthma, or season allergies; treated with topical corticosteroids

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93
Q

What is Atopic Keratoconjunctivitis?

A

more chronic disorder of adulthood that results in forniceal shortening and entropion with trichiasis; upper and lower tarsal conjunctivitis have papillary conjunctivitis; treated with corticosteroids

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94
Q

How is Allergic Conjunctivitis typically treated?

A

topical anthihistamines, NSAIDs, mast cell stabilizers, or a combination
topical corticosteroids
avoidance of allergic triggers
antigen desensitization

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95
Q

What is Keratoconjunctivitis Sicca?

A

Dry Eyes

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96
Q

What is conjunctival injection?

A

the dilation of conjunctival vessels

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97
Q

What are causes of Keratoconjunctivitis sicca?

A

age-related
part of Sjorgren’s Syndrome, RA, or SLE
result of conditions that scare tear ducts, such as Steven-Johnson syndrome or trachoma

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98
Q

What are symptoms of Keratoconjunctivitis sicca?

A 
dryness
redness
foreign body sensation ('gritty or sandy' feeling)
in severe cases:
photosensitivity
eye strain
blurry vision
discomfort
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99
Q

What are you likely to see when you examine an eye with Keratoconjunctivitis sicca?

A

conjunctival injection

scattered, fine, punctate loss of cornea epithelium and conjunctival epithelium

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100
Q

How might Keratoconjunctivitis sicca be diagnosed? What tests are done?

A

not typically diagnosed in an office
Schirmer test - measures the rate of production of the aqueous component of tears
Tear Break-up Test (TBUT)
slit-lamp - may see abnormalities in tear film stability and tear film meniscus
in severe cases: damaged corneal and conjunctival cells can be seen using 1% rose Bengal stain

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101
Q

How is Keratoconjunctivitis treated?

A

artificial tears
cyclosporine opthalmic emulsion (restasis)
lacrimal punctal occlusion by canicular plugs or cautery in sever cases

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102
Q

Are tumors of the eye usually benign or malignant?

A

benign, but the most common malignant tumor is basal cell carcinoma

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103
Q

Is Pinguecula and Pterygium usually bilateral or unilateral?

A

bilateral

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104
Q

What is Pinguecula?

A

a raised yellowish mass within the bulbar conjunctiva, adjacent to the cornea

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105
Q

In what age group is Pinguecula commonly seen?

A

adults over the age of 35

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106
Q

What is the prognosis of Pinguecula?

A

usually does not grow, but can become inflamed

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107
Q

What is Pterygium?

A

a thickening of conjunctiva in the shape of a triangle usually on the nasal side growing inward toward the cornea

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108
Q

What are common symptoms of Pterygium?

A

decreased vision (especially if it grows to cover the cornea), red eye, irritation, and foreign body sensation

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109
Q

In what circumstances does Pterygium most commonly occur?

A

tropical climates
tend to be found in males
genetic factors may be involved

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110
Q

What can cause Pterygium?

A

prolonged exposure to wind, sun, sand, and dust

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111
Q

What is the prognosis of Pterygium?

A

can become inflamed and grow

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112
Q

How is Pinguecula and Pterygium treated?

A

no treatment is required for inflammation, but short period treatment with topical NSAIDs or weak corticosteroid drops may help
artificial tears
surgical removal

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113
Q

What is a Corneal Ulcer?

A

an open sore on the cornea

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114
Q

What are common causes of corneal ulcers?

A

commonly associated with contact lens use, eye trauma (foreign body), and eyelid abnormalities
Infectious - bacterial, viral, fungal, and amoebas
Non-infectious - neurotrophic keratitis, exposure keratitis, dry eye, allergic eye disease, or other inflammatory disorders

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115
Q

What are symptoms of Corneal Ulcers?

A 
pain
photophobia
tearing
reduced vision/decreased visual acuity
may be accompanied by hyperemia and hypopyon (layering of white blood cells in the anterior chamber)
purulent or watery discharge
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116
Q

How are Corneal Ulcers diagnosed?

A

slit-lamp examination
all but the smallest ulcers are cultured
fluorescein staining - defect will appear bright green under blue light

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117
Q

What tests might you order to diagnose Corneal Ulcers?

A

check visual acuity and visual fields
check for foreign bodies that might be causing the ulcer
possible gram stain and culture

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118
Q

How are Corneal Ulcers Treated?

A

initially empiric topical broad-spectrum antibiotic therapy around the clock

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119
Q

When should Corneal Ulcers be referred?

A

any patient with an acute painful red eye and corneal abnormality should be referred emergently to an ophthalmologist

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120
Q

What is Infectious Keratitis?

A

an inflammation of the cornea caused by bacteria, virus, fungus, or parasites (Acanthamoeba)

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121
Q

What causes Bacterial Keratitis?

A

Pseudomonas aeruginosa, Moraxella species, and other gram-negative bacilli; staphylococci (MRSA), and streptococci

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122
Q

What are risk factors for Bacterial Keratitis?

A

wearing contact lenses

corneal trauma

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123
Q

What are common symptoms of Bacterial Keratitis?

A 
eye redness
eye pain
excess tears or other drainage
blurred vision
photophobia
foreign body sensation
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124
Q

What presentations might you see when examining Bacterial Keratitis?

A

cornea is hazy
ulcer and adjacent stromal abscess
hypopyon

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125
Q

How might Bacterial Keratitis be diagnosed?

A

gram stain and culture

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126
Q

How is Bacterial Keratitis treated?

A

high-concentration topical antibiotic drops applied hourly for 48 hours

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127
Q

When should you refer Bacterial Keratitis?

A

any patient with suspected Bacterial Keratitis must be referred emergently to an ophthalmologist

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128
Q

Why is diagnosis of Herpes Simplex Keratitis important?

A

It is an important cause of ocular morbidity

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129
Q

How does Herpes Simplex reach the eyes, and what contributes to its recurrence?

A

Herpes Simplex colonizes the trigeminal ganglion, leading to recurrences precipitated by fever, excessive exposure to sunlight, or immunodeficiency

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130
Q

What does Herpes Simplex usually cause or manifest as in the eyes?

A

manifests as eyelid, conjunctival, and corneal ulceration

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131
Q

What is a hallmark symptom of Herpes Simplex Keratitis?

A

dendritic branching

corneal ulcer

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132
Q

How is Herpes Simplex Keratitis diagnosed?

A

clinical exam
fluorescein stain with blue light
viral culture if diagnosis is in doubt

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133
Q

How is Herpes Simplex Keratitis treated?

A

debridement and patching
topical antivirals
occasionally systemic antivirals

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134
Q

What treatment should NOT be used for Herpes Simplex Keratitis and why?

A

topical corticosteroids may lead to corneal ulcers if used to treat Herpes Simplex Keratitis

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135
Q

When should Herpes Simplex Keratitis be referred?

A

any patient with a history of herpes simplex eye infection and an acute red eye should be referred urgently to an ophthalmologist

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136
Q

How does Herpes Zoster Ophthalmicus affect the eye?

A

involves the ophthalmic division of the trigeminal nerve

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137
Q

What is an important risk factor for Herpes Zoster Ophthalmicus?

A

HIV

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138
Q

What are common symptoms of Herpes Zoster Ophthalmicus?

A

malaise
fever
headache
preorbital burning or itching (for day or longer)
rash is initially vesicular, becoming pustular, and then crusting
involvement with the tip of the nose or lid margins predicts involvement with the eye

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139
Q

How might Herpes Zoster Ophthalmicus present upon examination?

A

ocular signs include: conjunctivitis, keratitis, episcleritis, and anterior uveitis
high intraocular pressure

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140
Q

How is Herpes Zoster Ophthalmicus treated?

A

oral antivirals
topical antivirals
anterior uveitis is treated with topical corticosteroids and cycloplegics

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141
Q

When should Herpes Zoster Ophthalmicus be treated?

A

• any patient with herpes zoster ophthalmicus and ocular symptoms or signs should be referred urgently to an ophthalmologist

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142
Q

How might a patient contract Fungal Keratitis?

A

a corneal injury involving a plant material or in an agricultural setting

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143
Q

Who is most at risk for Fungal Keratitis?

A

contact lens wearers

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144
Q

What might one see when examining Fungal Keratitis?

A

multiple stromal abscesses

little epithelial loss (indolent/lazy progression)

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145
Q

How is Fungal Keratitis diagnosed?

A

corneal scraping culture

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146
Q

What is the treatment for Fungal Keratitis and what might impede treatment?

A

topical or systemic antifungals
grafting is required
diagnosis tends to be delayed and treatment is difficult

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147
Q

What is Acanthamoeba Keratitis?

A

keratitis caused by amoeba

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148
Q

Who is most at risk for Acanthamoeba Keratitis?

A

contact lens wearers

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149
Q

What are common symptoms of Acanthamoeba Keratitis?

A

severe pain

perineural and ring infiltrates in cornaeal stroma is characteristic but not specific

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150
Q

How is Acanthamoeba diagnosed?

A

culture requres special media

confocal microscopy

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151
Q

How is Acanthamoeba treated?

A

long-term intensive topical biguanide and diamidine (long-term is required because of the organism’s ability to encyst within corneal stroma)
corneal grafting may be required

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152
Q

What treatment should NOT be used for Acanthamoeba Keratitis?

A

corticosteroids may adversely affect visual outcome

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153
Q

What is Acute Angle-Closure Glaucoma?

A

involves a physically obstructed anterior chamber angle

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154
Q

What can cause Acute-Angle Closure Glaucoma?

A

primarily results form the forward ballooning of the iris so that it reaches the back of the cornea, obstructing the anterior chamber filtration angle and reducing the outflow of aqueous humor; a pre-exisiting narrow angle closed by pupillary action (dark room, stress)

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155
Q

What are essential factors in the diagnosis of Acute Angle-Closure Glaucoma?

A 
older age group, particularly in farsighted individuals
rapid onset with severe pain
visual loss with "halos around lights"
hard eye palpation
high IOP
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156
Q

How does the causation vary for Primary Acute Angle-Closure Glaucoma, and Secondary Acute Angle-Closure Glaucoma?

A

Primary - involves pre-existing narrow angle

Secondary- NO pre-existing narrow angle; caused by anterior uveitis, dislocation of the lens, or due to certain drugs

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157
Q

What are risk factors for Acute Angle-Closure Glaucoma?

A 
family history
farsightedness or short stature
more common in Asians and Inuits
hypertension
diabetes
cardiovascular disease
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158
Q

What are common symptoms of Acute Angle-Closure Glaucoma?

A 
rapid onset
extreme pain
blurred vision - usually with "halos around lights"
nausea
abdominal pain
headache
possible blindness
reduced visual acuity
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159
Q

How might Acute Angle-Closure Glaucoma appear under examination?

A 
red eye
cloudy cornea
pupil dilation is non-reactive
intraocular pressure greater than 50 (normal is 10-20)
hard eye palpation
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160
Q

How might Acute Angle-Closure Glaucoma be treated?

A

agents that decrease the production or secretion of aqueous humor
laser iridotomy (punctures hole in iris to allow drainage)
oral diuretics will draw fluid from the eyes
treatment is aimed at preventing further damage

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161
Q

When should you refer Acute Angle-Closure Glaucoma?

A

emergently!

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162
Q

If a patient comes to you with ____ ____, ___, and ___; examine the eyes!

A

sudden headache
nausea
vomiting

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163
Q

What is Chronic Open-Angle Glaucoma?

A

multifactorial optical neuropathy that is chronic, progressive, and irreversible with characteristic loss of optic nerve fibers

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164
Q

What causes Chronic Open-Angle Glaucoma?

A

decreased permeability through the trabeculae inot the canal of Schlemm leads to increased intraoccular pressure

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165
Q

What percentage of Glaucoma cases are Chronic Open-Angle?

A

90%

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166
Q

What are essential components to Chronic Open-Angle Glaucoma?

A

no symptoms in early stages
insidious bilateral loss of peripheral vision, resulting in tunnel vision
preserved visual acuity until advanced disease
pathologic cupping of the optic disks
intraocular pressure is elevated

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167
Q

In what group does Chronic Open-Angle Glaucoma most often occur?

A

African Americans and Hispanics - occurs at earlier age and results in more severe optic nerve damage

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168
Q

What are symptoms of Chronic Open-Angle Glaucoma?

A

early disease - asymptomatic
loss of peripheral vision - may progress to tunnel vision
bumping into objects

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169
Q

Is Chronic Open-Angle Glaucoma usually bilateral or unilateral?

A

bilateral

170
Q

How is Chronic Open-Angle Glaucoma usually diagnosed, and what criteria must be met?

A

usually diagnosed upon eye-screen exam
consistent and reproducible abnormalities in at least two: optic disk swelling or retinal nerve fiber layer, visual field, intraocular pressure

171
Q

How is Chronic Open-Angle Glaucoma generally treated?

A

prostaglandin drops (increase outflow of aqueous humor)
beta-adrenergic blockers
laser therapy and surgery

172
Q

What is Uveitis?

A

nonspecific term for intraocular inflammation

173
Q

What makes up the anterior uvea?

A

iris and/or ciliary body

174
Q

What makes up the intermediate uvea?

A

structures just posterior to the lens

175
Q

What makes up the posterior uvea?

A

choroid, retina, vitreous

176
Q

How is Uveitis categorized?

A

By area in the uvea: anterior, intermediate, or posterior; also by Acute Non-granulomatous Anterior Uveitis, Granulomatous Anterior Uveitis, and Posterior Uveitis

177
Q

What causes Uveitis?

A 
usually immunologic, but can be infective or neoplastic
idiopathic
isolated eye disease
medications
toxins
trauma
178
Q

What symptoms differentiate the different sub-categories of Uveitis?

A

Acute Non-granulomatous Anterior Uveitis: deep eye pain, redness, photophobia, and visual loss
Granulomatous Anterior Uveitis: blurred vision, mildly inflammed
Posterior Uveitis: gradual loss of vision in quiet eye, un-resolving floaters, commonly bilateral

179
Q

Where is Uveitis more common?

A

the developing world

180
Q

What are common symptoms of Uveitis?

A

decreased visual acuity
pain
photophobia
blurry vision

181
Q

How might Anterior Uveitis look under examination?

A

inflammatory cells and flare within the aqueous
conjunctival vessel dilation
ciliary flush (redness)
small pupil size of affected eye (usually only one)
hypopyon and fibrin in sever cases
KP precipitates (keratic) and iris nodules

182
Q

How might Intermediate Uveitis look under examination?

A

aggregates and condensations of inflammatory cells forming “snowballs”

183
Q

How might Posterior Uveitis appear under examination?

A 
bilateral cells in the vitreous humor
white or yellow lesions in the retina (retinitis)
choroiditis
exudative retinal detachments
retinal vasculitis
optic disk edema
slit-lamp exam
-look for inflamed cells
184
Q

How is Anterior Uveitis treated?

A

topical steroids
injected or systemic steroids
pupil dilation

185
Q

How are Intermediate and Posterior Uveitis treated?

A

systemic, periocular, or intravitreal corticosteroids

occasionally systemic immunosuppression

186
Q

When should Uveitis be referred?

A

Urgently for both, but particularly Acute

187
Q

Is Uveitis typically bilateral or unilateral?

A

Anterior Uveitis is usually unilateral, while Posterior Uveitis is usually bilateral

188
Q

What is a Cataract?

A

opacity or discoloration of the lens

189
Q

Why is the Cataract so important to know about?

A

Leading cause of world blindness

190
Q

What are essential components to Cataract diagnosis?

A

gradually progressive blurred vision
No pain or redness
lens opacities

191
Q

What types of Cataracts are there?

A 
age-related (90%)
metabolic
congenital (lens opacity within 3 months of age)
systemic disease association
secondary eye disease
traumatic
inhalation of corticosteroids
192
Q

How are age-related cataracts caused?

A

continual addition of lens fibers, causing denser lens, which is hard to see through

193
Q

What can cause congential Cataract?

A 
idiopathic
drugs taken by mother in the first trimester
metabolic disease of the mother
intrauterine infection
maternal malnutrition
194
Q

What are risk factors for Cataracts?

A 
aging
smoking
UV sun exposure
diabetes 
prolonged steroid exposure
alcohol
195
Q

What is the predominant symptom of Cataracts?

A

progressive blurring vision

196
Q

Are Cataracts usually bilateral or unilateral?

A

usually bilateral, but asymmetric; can be unilateral, but watch for development in the other eye

197
Q

What are symptoms of age-related Cataracts?

A 
decreased visual acuity
blurry vision
distorted or "ghosting" images
glare, especially while driving
falls
loss of color vision
double vision
198
Q

What are symptoms of Congenital cataract?

A

none; asymptomatic
under exam: leukocoria - white pupil when exposed to red light (red light test)
nystagmus
RULE OUT TUMOR

199
Q

How are cataracts usually treated?

A

surgery - most commonly performed surgical procedure; improves visual acuity in 95% of cases

200
Q

When should you refer cataracts?

A

when visual impairment adversely affects the patient’s lifestyle

201
Q

What are essential components to diagnosing Retinal Detachment?

A

loss of vision in one eye that is usually rapid, possibly with curtain spreading across field of vision
no pain or redness
detachment seen in opthalmoscopy

202
Q

How does Retinal Detachment occur?

A

most cases are due to one or more retinal tears or holes
may be caused by penetrating or blunt ocular trauma
traction from posterior vitreous detachment
fluid build-up and resulting detachemnt

203
Q

What are the two most common predisposing factors for Retinal Detachment? In what age group does it most commonly occur?

A

nearsightedness and cataract extraction; people over 50

204
Q

What are common symptoms of Retinal Detachment?

A

showers of floaters; moving spots or streaks
photopsias
visual vield loss; “curtain coming across vision”
central vision loss if macula is involved
visual acuity of 20/200 or worse

205
Q

How is Retinal Detachment diagnosed?

A

slit-lamp exam
dilated fundus with ophthalmoscope
may find one or more retinal holes or tears

206
Q

What is the treatment for Retinal Detachment?

A

not all tears are treated, but many are closed, sometimes wiht a laser
intraocular gases to hold retina in place
surgical reattachment
prognosis correlates with duration of symptoms and size of holes

207
Q

When will you refer Retinal Detachment?

A

all cases urgently
emergently when central vision is intact
position had back during transportation, so retina stays in place

208
Q

What is a Vitreous Hemorrhage?

A

leakage of blood into the areas in and around the vitreous humor of the eye

209
Q

How is a Vitreous Hemorrhage caused?

A 
retinal tear
diabetic or sickle-cell retinopathy
retinal vein occlusion
retinal vasculitis
neovascular age-related degeneration
blood dyscrasia
therapeutic anticoagulation
trauma
subarachnoid hemorrhage
severe straining
210
Q

What are symptoms of a Vitreous Hemorrhage?

A

sudden visual loss
abrupt onset of floaters that may progress in severity
report of “bleeding in the eye”
vision ranges from 20/20 to light perception

211
Q

What symptom will you not see with a Vitreious Hemorrhage?

A

no inflammation

212
Q

What symptoms will you not see with Retinal Detachment?

A

no pain or redness

213
Q

What will you see upon a Vitreous Hemorrhage examination?

A

inability to see fundus details becuase of blood

localized collection of blood in front of the retina

214
Q

What exams might you order to diagnose a Vitreous Hemorrhage?

A

eye exam with pupil dilation
ultrasound of the eye
labs for underlying causes
CT for underlying injury

215
Q

How is a vitreous hemorrhage treated?

A 
patches over eyes for limited movement
head at 30-45*
avoid blood thinners
retinal tears are closed with a laser
detached retinas are reattached surgically
216
Q

When do you refer a Vitreoius Hemorrhage?

A

Anytime one is suspected

217
Q

What are essential components to Age-Related Macular Degeneration?

A

older age group
acute or chronic deterioration of central vision in both eyes
distortion or abnormal size of images
no pain or redness
macular abnormalities seen in ophthalmoscopy

218
Q

What is Age-Related Macular Degeneration?

A

deterioration of the central portion of the retina called the macula, which is responsible for focusing central vision

219
Q

Why is Age-Related Macular Degeneration so awful?

A

it is the leading cause of blindness in patients 65 years of age or older in developed countries?

220
Q

What two types of Age-Related Macular Degeneration are there?

A

Dry and Wet; all cases of macular degeneration begin with the dry stage

221
Q

What are other names for Dry Age-Related Macular Degeneration?

A

atrophic and geographic

222
Q

What are other names for Wet Age-Related Macular Degeneration?

A

neovascular and exudative

223
Q

What are common causes or contributors to Age-Related Macular Degeneration?

A 
older age group (especially those over 50)
family history
smoking
regular aspirin users
cardiovascular disease
hypertension
sun exposure
lack of exercise/obesity
224
Q

In what groups are Age-Related Macular Degeneration most common?

A

caucasian
female
red or blond hair

225
Q

Is Age-Related Macular Degeneration usually bilateral or unilateral?

A

Unilateral

226
Q

What is a primary precursor for Age-Related Macular Degeneration?

A

drusen; discrete yellow deposits

227
Q

What is the primary symptom of Age-Related Macular Degeneration?

A

loss of central vision only

228
Q

What symptoms will not be present in Age-Related Macular Degeneration?

A

pain or redness

229
Q

How common is Dry Age-Related Macular Degeneration?

A

85% of cases

230
Q

What causes Dry Age-Related Macular Degeneration?

A

due to atrophy and degeneration of the outer retina and retinal pigment epithelium

231
Q

What are the symptoms for Dry Age-Related Macular Degeneration?

A

gradually progressive bilateral central vision

painless

232
Q

What might you see in a Dry Age-Related Macular Degeneration exam?

A

changes in retinal pigment epithelium
drusen
areas of chorioretinal atrophy

233
Q

How is Dry Age-Related Macular Degeneration treated?

A 
daily supplements to reduce risk of Wet ARMD:
zinc
copper
vitamin C
vitamin E
low-vision aids may help
234
Q

What is the occurrence of Wet Age-Related Macular Degeneration?

A

15% of cases, but accounts for 90% of blindness caused by ARMD

235
Q

What causes Wet Age-Related Macular Degeneration?

A

choroidal new vessels grow between the retinal pigment epithelium and Bruch membrane; new vessels are “leaky,” leading to accumulation of serous fluid, hemorrhage, and fibrosis

236
Q

What are symptoms of Wet Age-Related Macular Degeneration?

A

rapid onset of visual loss
visual distortion (central blind spot)
straight lines appear crooked
central vision gets darker until its gone

237
Q

What might you see in a Wet Age-Related Macular Degeneration Exam?

A

subretinal fluid
retinal edema
gray-green discoloration
exudates in or around macula
detachment of retinal pigment epithelium
subretinal hemorrhage in or around macula
soft drusen (larger and paler than hard drusen

238
Q

How is Wet Age-Related Macular Degeneration treated?

A

oral treatment of zinc, copper, antioxidants, and carotenoids
inhibitors of vascular growth factors
macular surgery
supportive measures (magnifiers, high-power reading glasses, large computer monitors, telescopic lenses, etc.)
corticosteroids
laser removal of neovascularizatoin

239
Q

How might you diagnose Age-Related Macular Degeneration?

A

funduscopic examination
color of fundus photography (wet is grey green)
fluorescein angiography
optical coherence tomography

240
Q

What is the prognosis for Age-Related Macular Degeneration?

A

damage is irreversible

treatment is aimed at limiting progression

241
Q

When would you refer Age-Related Macular Degeneration?

A

urgently in older patients who develop sudden vision loss

242
Q

What are essential components of Central and Branch Retinal Vein Occlusions?

A

sudden monocular loss of vision
no pain or redness
widespread or sectoral retinal hemorrhages

243
Q

Central and Branch Retinal Vein Occlusions are common causes of what?

A

acute vision loss (branch is 4 times as common)

244
Q

What are risk factors for Central and Branch Retinal Vein Occlusions?

A 
hypertension
age (over 50)
glaucoma
diabetes
increased blood viscosity
arrhythmia
cardiac vulvar disease
245
Q

What are common symptoms of Central and Branch Retinal Vein Occlusions?

A 
commonly first noticed upon waking
painless vision loss
can be sudden, but may be over days or weeks
no pain or redness
widespread sectoral retinal hemorrhages
246
Q

How would you examine for Central and Branch Retinal Vein Occlusions?

A 
fundoscopy:
widespread retinal hemorrhages
retinal venous dilation and tortuosity 
retinal cotton-wool spots
optic disk swelling
247
Q

What is a common sign of Central Retinal Vein Occlusion?

A

visual loss first noticed upon waking

248
Q

What is the presentation of Central Retinal Vein Occlusions?

A 
widespread retinal hemorrhages
retinal venous dilation 
tortuosity
rental cotton-wool spots
optic disk swelling
249
Q

What are symptoms of Branch Retinal Vein Occlusion?

A

may be present in a variety of ways
sudden loss of vision at the time of occlusion if fovea is involved or some time later if it is not
gradual vision loss with development of macular edema

250
Q

How is Branch Retinal Vein Occlusion diagnosed?

A

fundoscopy
color fundus photography
fluorescein angiography
optical coherence tomography

251
Q

How are Central and Branch Retinal Vein Occlusions treated?

A

generally treat symptoms
anti-vascular endothelial growth factor
focal laser photocoagulation
panretinal laser photocoagulation if neovascularization develops

252
Q

When should you refer Central and Branch Retinal Vein Occlusions?

A

urgently

253
Q

What are essential components in diagnosing Central and Branch Artery Occlusions?

A

suddon monolcular loss of vision
no pain or redness
widespread or sectoral retinal pallid swelling

254
Q

What are causes of Central and Branch Artery Occlusions?

A

embolus, thrombosis, diabetes mellitis, hyperlipidemia, hypertension, migraines, oral contraceptives

255
Q

What are symptoms of Central and Branch Artery Occlusions?

A

sudden
painless
profound vision loss
visual acuity is usually reduced to counting fingers or worse
visual field is restricted to an island of vision in temporal field

256
Q

What are key findings that might help diagnose Central and Branch Artery Occlusions?

A

pupil responds poorly to direct light, but constricts briskly when the other eye is illuminated
fundoscopy shows pale, opaque fundus with red fovea (cherry-red spot)
retinal arteries are attenuated, and “box-car” segmentation of blood in the veins may be seen

257
Q

What are symptoms of Central Artery Occlusion?

A

sudden profound monocular loss
visual acuity is usually reduced to counting or worse
visual field is reduced to an island of vision in the temporal field
pallid swelling of the retina
cherry-red spot at the fovea
retinal arteries are attenuated
box-car segmentation of blood in veins may be seen
emboli are seen in artery or its branches on occasion

258
Q

In patients over 50 that are diagnosed with Central Artery Occlusion, what else must be considered?

A

giant cell arteritis

259
Q

What are common symptoms of Branch Retinal Artery Occlusions?

A

sudden loss of vision if fovea is involved
sudded loss of visual field is the presenting complaint
fundal signs of retinal swelling and cotton-wool spots are limited to area of retina supplied by the occluded artery

260
Q

How are Central and Branch Artery Occlusions diagnosed?

A

clinical evaluation
color fundus photography
fluorescein angiography

261
Q

How are Central and Branch Artery Occlusions treated?

A

sometimes reduction of intraocular pressure
immediate treatment if within 24 hours of presentation: lower IOP, digital massage, anterior chamber paracentesis may dislodge
removal of material inside artery or angioplasty with stenting within two weeks

262
Q

If suspected Central and Branch Artery Occlusions, what else should be considered?

A

screen for corotid and cardiac sources of emboli to prevent possible stroke
screen for diabetes mellitus and hypertension

263
Q

When should Central and Branch Artery Occlusions be referred?

A

emergently, especially if caught soon after onset

264
Q

If suspicious of Central or Branch Artery Occlusion, what tests should be ordered?

A

identify carotid and cardiac sources of emboli
doppler ultrasonography and echocardiography to find underlying embolic source
if giant cell arteritis is suspected, platelet count should be done immediately

265
Q

When should you refer Central or Branch Artery Occlusion?

A

central - emergently
branch - urgently
giant cell arteritis - ADMIT!

266
Q

What is Transient Moncular Visual Loss?

A

monocular loss of vision usually lasting a few minutes with complete recover; ocular transient ischemic attack

267
Q

What is another name for Transient Moncular Visual Loss?

A

Amaurosis fugax (fleeting blindness)

268
Q

What causes Transient Moncular Visual Loss?

A

a retinal embolus from ipsilateral carotid disease or the heart

269
Q

What are symptoms of Transient Moncular Visual Loss?

A

A curtain passing vertically across the visual field with complete monocular visual loss lasting a few minutes and a similar curtain effect as the episode passes

270
Q

What might you see in a Transient Moncular Visual Loss exam?

A

nothing, an embolus is rarely seen

271
Q

What do you want to screen for if Transient Moncular Visual Loss is suspected?

A

the source of the embolus; it could lead to stroke

272
Q

How would you treat Transient Moncular Visual Loss?

A

oral apsirin or other anti-platelet drug, until cause has been determined
70-99% should be considered for urgent carotid endarterectomy or possibly angioplasty with stenting (prevent stroke)
anticoagulation
surgical treatment

273
Q

When should you refer Transient Moncular Visual Loss?

A

refer all cases of episodic visual loss; admit embolic transient visual loss if there were two or more episodes in the preceding week

274
Q

What is Diabetic Retinopathy?

A

noninflammatory retinal disorder characterized by retinal capillary closure and microaneurysms

275
Q

In what percentage of diabetic patients is Diabetic Retinopathy found?

A

35% of all cases, 20% of Type II

276
Q

What age group does Diabetic Retinopathy cause blindness in?

A

all, but it is the leading cause of blindness in adults 20-65 years of age

277
Q

How does Non-proliferative Diabetic Retinopathy present?

A 
before proliferative
increased capillary permeability
micro-aneurysms
dot and blot hemorrhages
exudates
macular ischemia
macular edema
venous bleeding
cotton-wool spots (soft-exudates)
venous dilation and intraretinal microvascular abnormalities
278
Q

What is generally the first sign of Non-proliferative Diabetic Retinopathy?

A

micro-aneurysms

279
Q

Compared to Non-proliferative, Proliferative Diabetic Retinopathy is more or less common?

A

less common, but more severe visual loss; develops after non-proliferative Diabetic Retinopathy

280
Q

What might Proliferative Diabetic Retinopathy lead to?

A

vitreous hemorrhage and traction retinal detachment

281
Q

What is Proliferative Diabetic Retinopathy characterized by?

A

abnormal new vessel formation occurring on the inner retinal surface

282
Q

What are symptoms of Proliferative Diabetic Retinopathy?

A

blurred vision
floaters (black spots)
flashing lights in the field of vision
sudden, severe, painless vision loss

283
Q

What might you see while examining Proliferative Diabetic Retinopathy?

A

neovascularization arising from either the optic disk or the major vascular arcades
vitreous hemorrhage
traction retinal detachment

284
Q

How might you treat Diabetic Retinopathy?

A

optimize blood glucose, blood pressure, kidney function, and serum lipids
annual exams
macular edema - anti-vascular endothelial growth factor

285
Q

When should you refer Diabetic Retinopathy?

A

all diabetic patients with sudden loss of vision or retinal detachment should be referred emergently to an ophthalmologist
proliferative urgently
nonproliferative referral

286
Q

What is Hypertensive Retinopathy?

A

Hypertensive Retinopathy is retinal or choroidal vascular damage due to hypertension.

287
Q

In what age group are the most florid ocular changes seen when diagnosing Hypertensive Retinopathy?

A

Young patients with abrupt blood pressure elevation.

288
Q

What are some common causes of Hypertensive Retinopathy, and what trademark presentations do they accompany?

A

Acute Elevation in Blood Pressure causes reversible vascular constriction.
A Hypertensive Crisis causes optic disk Edema.
Chronic or Severe Blood Pressure Elevation will cause exudative (leaky fluid) vascular changes, arteriole wall thickening, and arteriovenous nicking.

289
Q

What are primary risk factors related to Hypertensive Retinopathy?

A

smoking

diabeties

290
Q

What are common symptoms of Hypertensive Retinopathy?

A

blurry vision
visual field defects
- vision issues do not usually develop until late in the disease

291
Q

What can you expect to find when examining a patient with Hypertensive Retinopathy?

A

superficial flame-shaped hemorrhages
small, white, superficial foci of retinal ischemia (cotton-wool spots)
yellow hard exudates
optic disk edema

292
Q

How would you diagnose Hypertensive Retinopathy?

A

slit-lamp exam
fundoscopy
history - duration/severity of hypertension

293
Q

What would you see when examining a patient with Chronic Hypertensive Retinopathy?

A

arterial narrowing
tortuous retinal arteries
arteriovenous crossing abnormalities - “arteriovenous nicking”
arteriovenous with moderate vascular wall changes - “copper-wiring”
more sever vascular wall changes - “silver wiring”

294
Q

How would you treat Hypertensive Retinopathy?

A

Main Objective - Treat Hypertension!
You can treat the retinal edema with laser therapy or with intravitreal injection of corticosteroids or anti-vascular endotheleal growth factor.

295
Q

What is Blood Dyscrasias?

A

Blood Dyscrasias is a pathologic condition of the blood and usually refers to a disorder of the cellular elements of the blood.

296
Q

What general blood conditions may lead to retinal or choroidal hemorrhages?

A

Severe thrombocytopenia (low blood platelet count) or anemia (low red blood cell count)

297
Q

What is Sickle Cell Retinopathy?

A

Sickle Cell Retinopathy is a form of Blood Dyscrasias. It is common in hemoglobin SC disease, but may also occur in other hemoglobin S variants.

298
Q

What are symptoms of Blood Dyscrasias?

A

white centered retinal hemorrhages

involvement with the macula may result in permanent vision loss

299
Q

What are symptoms of Sickle Cell Retinopathy?

A

“salmon-patch” preretinal/intraretinal hemorrhages
“black sunbursts” resulting from intraretinal hemorrhage
new vessels
severe visual loss is rare, but more common in patients with pulmonary hypertension

300
Q

How would you treat Sickle Cell Retinopathy?

A

retinal laser photocoagulation reduces the frequency of vitreous hemorrhage from new vessels
surgery is occasionally needed for persistent vitreous hemorrhage or tractional retinal detachement

301
Q

What are signs of an HIV infection/AIDS in the eyes?

A

manifests clinically as cotton-wool spots
retinal hemorrhages
micro-aneurysms
may lead to reduced contrast sensitivity, retinal nerve fiber layer, and outer retinal damage

302
Q

What is CMV Retinitis?

A

a sight-threatening complication of HIV/AIDS, chemotherapy, and bone marrow transplants

303
Q

What are symptoms of HIV Infection/AIDS in the eyes?

A

progressively enlarging yellowish-white patches of retinal opacification
retinal hemorrhages
retinal vascular arcades
patients are often asymptomatic until there is involvement of the fovea or optic nerve, or until retinal detachment develops

304
Q

List three initial treatments for HIV/AIDs in the eyes.

A

valganciclovir 900 mg orally twice daily for 3 weeks
ganciclovir 5 mg/kg, forscarnet 60 mg/kg, or cidofovir 5 mg/kg intravenously
local administration of gancicloviror foscarnet, or sustained-release ganciclovir intravitreal implant

305
Q

What is Ischemic Optic Neuropathy?

A

Ischemic Optic Neuropathy is sudden visual loss due to obstructed blood flow to the optic nerve.

306
Q

What are essential diagnoses of Ischemic Optic Neuropathy?

A

Sudden painless visual loss with signs of optic nerve dysfunction, and optic disk swelling in anterior ischemic optic neuropathy.

307
Q

What causes Ischemic Optic Neuropathy?

A

Inadequate perfusion of the posterior ciliary arteries that supply the anterior portion of the optic nerve.

308
Q

What causes Ischemic Optic Neuropathy?

A 
may be caused by giant cell arteritis
hypertension
diabetes mellitus
hyperlipidemia
thrombophilia (blood clot disorder)
sleep apnea
309
Q

What are common symptoms of Ischemic Optic Neuropathy?

A

sudden visual loss
altitudinal field defect
optic swelling

310
Q

How is Ischemic Optic Neuropathy diagnosed?

A

Fundoscopy

311
Q

How is Ischemic Optic Neuropathy treated?

A

Emergency high-dose systemic corticosteroid treatment to prevent visual loss in the other eye

312
Q

When would you refer Ischemic Optic Neuropathy?

A

Urgently to an ophthalmologist; admit patients with giant cell arteritis

313
Q

What is Optic Neuritis?

A

Optic Neuritis is inflammation of the optic nerve that is strongly associated with demyelinating disease, particularly multiple sclerosis.

314
Q

What are essentials of diagnosis for Optic Neuritis?

A

subacute unilateral visual loss with signs of optic nerve dysfunciton
pain exacerbated by eye movements
optic disk usually normal in acute stage but subsequently develops pallor

315
Q

What group of people are diagnosed with Optic Neuritis most often?

A

Patients with a demyelinating disease, especially multiple sclerosis. It arises in people ages 20-40 (prime subjects for multiple sclerosis).

316
Q

What are common causes of Optic Neuritis?

A 
demyelinating diseases
infectious diseases (especially in cases involving children)
tumor mestastases to optic nerve
chemicals, drugs
neuromyelitis optica
317
Q

What are common symptoms of Optic Neuritis?

A 
abrupt, unilateral vision loss (hours to days)
visual acuity ranges form 20/30 to no perception of light
field loss is usually central
periorbital pain with eye movement
brow ache, globe tenderness
dimness in light intensity
loss of color vision
afferent pupillary affect
318
Q

What will Optic Neuritis look like in an exam?

A

papilitis: swollen optic disk
flame-shaped hemorrhage
temporal disk pallor (4-6 weeks after swelling)
RAPD (Marcus-Gun Pupil)
2/3 patients will have normal disk inflammation

319
Q

What is RAPD or Marcus-Gunn pupil?

A

The pupil of the affected eye dilates during the swinging light test. It will not constrict when the light is shining on it.

320
Q

What is Optic Neuritis often a presenting manifestation of?

A

Multiple Sclerosis

321
Q

How is Optic Neuritis treated?

A 
Intravenous Methylprednisolone
corticosteroids
low-vision aids
will help improve some of vision, but de-myeletaion disease will progress optic neuritis
visual acuity improves in 2-3 weeks
322
Q

When should Optic Neuritis be referred?

A

Refer Urgently

323
Q

What causes Optic Disk Swelling?

A

intraocular disease: central retinal vein occlusion, posterior uveitis, posterior scleritis
orbital and optic nerve lesions
severe hypertensive retinochoroidapathy
raised intra-cranial pressure

324
Q

What is Papilledema?

A

Optic disk swelling due to raised intra-cranial pressure.

325
Q

Is Papilledema usually unilateral or bilateral?

A

bilateral

326
Q

What symptom usually occurs with Optic Disk swelling?

A

Optic disk swelling usually produces visual field loss without loss of acuity

327
Q

What symptoms are associated with Chronic Optic Disk Swelling?

A

visual field loss and occasionally profound loss of acuity

328
Q

What tests need to be ordered when Optic Disk swelling is found and why?

A

Urgent imaging is needed to exclude an intracranial mass or cerebral venous sinus occlusion as the cause.

329
Q

What vision impairment are Optic Disk Drusen associated with?

A

farsightedness

330
Q

What might Optic Disk Drusen be mistaken for and why?

A

Optic disk swelling because Optic Disk Drusen cause disk elevation

331
Q

How can you identify Optic Disk Drusen?

A

Drusen are yellowish-white spots that may be obvious clinically or can be demonstrated by their autofluorescence. Buried drusen are best detected by orbital ultrasound or CT scanning.

332
Q

What cranial nerves cause Ocular Motor Palsies?

A

Cranial nerves III, IV, and VI, which innervate the extraocular muscles.

333
Q

What can cause Ocular Motor Palsies?

A 
multiple sclerosis
Guillian-Barre syndrome
diabetes mellitus
infections
giant cell arteritis
hypertension
trauma to the eye
lesions
334
Q

What are symptoms of Ocular Motor Palsies?

A 
double vision
pain on movement
pain around the eyes
headache
nausea
335
Q

What Ocular Motor Palsy causes one eye to look down and to the side?

A

3rd Nerve Palsy - the III ocular nerve controls all ocular muscles except the lateral rectus (moves eye laterally) and the superior oblique (allows for clockwise downward rotation). All movement is restricted except laterally.

336
Q

What Ocular Motor Palsy causes the eye to turn inward?

A

4th nerve palsy - the IV ocular nerve controls the superior oblique. Palsy prevents downward rotation. All movement is restricted except inward rotation.

337
Q

What palsy restricts lateral movement of the eye?

A

6th Nerve Palsy. VI Ocular Nerve controls the lateral oblique function. All movement is restricted except medially.

338
Q

What is Stabismus?

A

misalignment of the eyes; cross-eyes; one of the most common eye problems in children

339
Q

What are causes of Stabismus?

A 
usually an eye muscular issue
refractive error
muscle imbalance
rare: retinoblastoma, cranial nerve palsy
could be infantile or acquired
340
Q

What are risk factors for Stabismus?

A 
family history
genetic disorder (Down Syndrome)
prenatal drug exposure
prematurity/ low birth weight
cerebral palsy
congenital eye defects
341
Q

How is Stabismus usually diagnosed?

A

physical and neurologic examinations at well-child check-ups
tests: corneal light reflex, alternate cover, cover-uncover
prisms

342
Q

How is Stabismus treated?

A

patching or atropine drops for attendant amblyopia
contact lenses or eyeglasses for refractive error
eye exercises for convergence insufficiency
surgical alignment

343
Q

Tropia

A

Strabismus that manifests with both eyes open

344
Q

Phoria

A

latent Strabismus, observed when one eye is covered

345
Q

Pseudostrabismus

A

eye position that appears to look like strabismus, but is a result of a broad bridge of the nose. It is not actually Strabismus.

346
Q

Esotropia

A

One or both eyes turning upward

347
Q

Exotropia

A

One or both eyes turning outward

348
Q

What is Nystagmus?

A

involuntary eye movement; also called dancing eyes

349
Q

What is a symptom of Nystagmus?

A

Nystagmus causes reduced or limited vision

350
Q

What causes Horizontal Nystagmus?

A

may be due to inner ear problems or lesions

351
Q

What is Congential Nystagmus?

A

Nystagmus that develops in infants between 6 weeks to 3 months of age. It is usually bilateral, may be inherited, and causes blurry vision.

352
Q

What is Acquired Nystagmus?

A

Nystagmus associated with serious medical conditions or drug and alcohol use. Patients report that things around them look shaky.

353
Q

What are causes of Nystagmus?

A 
family history
albinism
Meniere's Disease
Multiple Sclerosis
Stroke
Head Injury
Eye Problems (Cataracts, Strabismus)
Medications
Alcohol and Drug Abuse
354
Q

What are symptoms of Nystagmus?

A 
rapid eye movements
sensitivity to light
dizziness
difficulty seeing in the dark
vision problems
holding the head in a turned or tilted position
the feeling that the world is shaking
355
Q

How is Nystagmus diagnosed?

A

physical exam

CT or MRI (may be looking for underlying abnormalities)

356
Q

How is Nystagmus treated?

A

glasses
surgery
treatment of underlying disorder

357
Q

What is Thyroid Eye Disease?

A

a syndrome in which the orbital tissues are infiltrated by chronic inflammatory cells and mucopolysaccharides; particularly the extraocular muscles; results in abnormal clinical and orbital imaging; • an autoimmune disease that leads to overactivity of the thyroid gland; the back of the eyes are attacked by the immune system, resulting in inflammation and swelling; may push the eyes forward

358
Q

What are common symptoms of Thyroid Eye Disease?

A 
surface irritation
diplopia
proptosis
lid retraction and lid lag
conjuctival chemosis
episcleral inflammation
extraocular dysfunction
359
Q

How is Thyroid Eye Disease diagnosed?

A

clinical findings

CT - enlargement of the extraocular muscles, usually affecting both orbitals

360
Q

How is Thyroid Eye Disease treated?

A

systemic corticosteroids
radiotherapy
peribulbar corticosteroid injections
surgical decompression with marked proptosis
lateral tarsarrhaphy (surgically joining of the eyelids)

361
Q

What is chemosis?

A

swelling of the conjunctiva

362
Q

What is Orbital Cellulitis?

A

infection of the orbital tissues

363
Q

What causes Orbital Cellulitis?

A

most often - extension of infection from adjacent sinuses

less common - direct infection

364
Q

What are symptoms of Orbital Cellulitis?

A 
swelling and redness of the eyelid and surrounding tissues
conjunctival hyperemia and chemosis
decreased ocular motility
pain with eye movements
decreased visual acuity
proptosis
fever
365
Q

How is Orbital Cellulitis treated?

A

hospitalization and treatment with meningitis-dose antibiotics
surgery indicated for: compromised vision, abscess or foreign body

366
Q

What is Periorbital Cellulitis?

A

infection f the eyelid and surrounding tissues

367
Q

What causes Periorbital Cellulitis?

A

contiguous spread form local facial or eyelid injuries, insect or animal bites, conjunctivitis, chalazion, or sinusitis

368
Q

What are symptoms of Periorbital Cellulitis?

A 
tenderness
swelling
warmth
redness and discoloration
sometimes fever
369
Q

How is Periorbital Cellulitis treated?

A

antibiotics against sinusitis pathogens

370
Q

How is Periorbital Cellulitis and Orbital Cellulitis diagnosed? What other tests are ordered?

A

clinical
CT or MRI for orbtial cellulitis (see how far infection has spread
blood cultures for orbital cellulitis

371
Q

How might you differentiate between orbital cellulitis and blepharitis?

A

Blepharitis is localized, while orbital cellulitis will spread to the entire eye

372
Q

What are some symptoms of Conjunctival and Corneal Foreign Bodies?

A

foreign body sensation
tearing
redness
occasionally discharge

373
Q

How are foreign bodies diagnosed?

A

Patient says that there is something in their eye and gives a consistent history. Foreign bodies can be verified under a slit-lamp examination, usually with fluorescein staining.

374
Q

How foreign bodies in the eye treated?

A

irrigation or removal with a damp, cotton-tipped swab or small needle
bacitracin-polymyxin ophthalmic ointment
rust rings from iron must be excised by scraping or with a low-speed rotary burr
intraocular foreign body - EMERGENCY treatment from an ophthalmologist

375
Q

How are Corneal Abrasions diagnosed?

A

history of trauma to the eye - tends to involve a fingernail, piece of paper, or contact lens
examination with a light
fluorescein stainging if needed

376
Q

What are symptoms of a Corneal Abrasion?

A

severe pain
photophobia
tearing
foreign body sensation

377
Q

How are Corneal Abrasions treated?

A

bacitracin-polymyxin ophthalmic ointment
mydriatic
analgesics either topical or oral nonsteroidal anti-inflammatory agents

378
Q

What are typical symptoms of Contusions-Closed Globe Injuries?

A 
Eyelid Ecchymosis
Minor Lid Lacerations
Conjuctival, anterior chamber, or vitreous hemorrhage
retinal hemorrhage, edema, or detachment
laceration of the iris
cataract
dislocated lens
glaucoma
globe rupture (laceration)
379
Q

What is Eyelid Ecchymosis?

A

a black eye

380
Q

What are minor lid lacerations?

A

lacerations that do not involve the lid margin or tarsal plate - may be repaired with nylon sutures;
lacerations involveing the lid margin should be repaired by an ophthalmologist

381
Q

When and how would you examine Contusions/ Closed Globe Injuries?

A 
Evaluation can be difficult when massive lid edema or laceration is present. Unless immediate need for eye surgery, attempt to evaluate:
visual acuity 
pupil shape and pupillary responses
extraocular movements
anterior chamber depth or hemorrhage
presence of red reflex
382
Q

When would you suspect a Globe Laceration?

A

corneal or scleral laceration visible
aqueous humor is leaking (positive Seidel sign)
anterior chamber is very shallow (eg, making the cornea appear to have folds) or very deep (due to rupture posterior to the lens)
pupil is irregular

383
Q

How would you treat a Contusion/Closed Globe Injury?

A

apply a protective shield
systemic antimicrobials as for intraocular foreign bodies
if vomiting, give antiemetics
tetanus prophylaxis

384
Q

When would you refer a Contusion/ Closed Globe Injury?

A

Always refer immediately to an ophthalmologist

385
Q

What is Hyphema?

A

an anterior chamber hemorrhage; pooling or collection of blood inside the anterior chamber

386
Q

What can also occur with Hyphema?

A

Any injury causing hyphema involves the danger of secondary hemorrhage, which may cause glaucoma with permanent visual loss. Intraocular pressure can rise and should be monitored every day for a few days and regularly for weeks to months.

387
Q

How is Hyphema treated?

A

bed rest with head elevated 30-40*
eye shield to protect eye from further trauma
aspirin and any drugs inhibiting coagulation should be avoided

388
Q

What disease can adversely affect the outcome of Hyphema?

A

Sickle Cell Anemia

389
Q

What is Subconjunctival Hemorrhage?

A

bleeding under the conjunctiva

390
Q

What causes Subconjunctival Hemorrhages?

A

sudden or severe sneeze, cough, heavy lifting, straining, vomiting, or even rubbing one’s eyes too roughly
can be a side effect of eye surgery or blood thinners

391
Q

What are symptoms of Subconjunctival Hemorrhages?

A

bright red patch in the eye that may spread and become green or yellow (disappears within two weeks)

392
Q

How are Subconjunctival Hemorrhages treated?

A

They are not. They go away on their own in about two weeks

393
Q

What is a Lens Dislocation?

A

a lens that has moved out of position because some or all of the supporting ligaments have broken

394
Q

What causes Lens Dislocation?

A

trauma

some hereditary conditions predispose patients to weak ligaments (Marfans)

395
Q

What are symptoms of Lens Dislocation?

A

blurry vision

iris may quiver

396
Q

How are Lens Dislocations diagnosed?

A

lens appears off center on eye exam or dilation

397
Q

How are Lens Dislocations treated?

A

condition is permanent

vision corrected with glasses

398
Q

What is an Orbital Fracture or “Blow Out” Fracture?

A

a blunt trauma forces the orbital contents through one of the most fragile portions of the orbital wall, typically the floor

399
Q

What are symptoms of Blow Out Fracture?

A

diplopia - double vision
enophthalmos - posterior displacement of the eyeball
inferiorly displaced globe
hypesthesia (diminished capacity for physcial sensation) of the cheek and upper lip
subcutaneous emphysema (gas or air in a layer of the skin)
epistaxis, led edema, and ecchymosis

400
Q

How is a Blow Out Fracture diagnosed?

A

CT scan

401
Q

How is a Blow Out Fracture Treated?

A

Surgical repair if more than two weeks of diplopia or unacceptable enophthalmos

402
Q

Emmetropia

A

the normal refractive condition of the eye in which, with accommodation relaxed, parallel rays of light are brought accurately to a focus upon the retina

403
Q

Accommodation

A

the process of increasing the curvature of the lens

404
Q

Hyperopia

A

farsightedness; the eyeball is shorter than normal and the parallel rays of light are brought to focus behind the retina; objects at infinity are not seen clearly unless accommodation is used; objects closer to infinity may not be seen because accommodation is finite

405
Q

What are symptoms of Hyperopia?

A

may cause headaches and blurring of vision

406
Q

How is Hyperopia treated?

A

Can be corrected with convex lenses, which aid the refractive power of the eye in shortening the focal distance

407
Q

Myopia

A

nearsightedness; the anteroposterior diameter of the eyeball is too long; unaccommodated eye focuses on objects closer than infinity
objects beyond a close distance cannot be seen without biconcave lenses

408
Q

What are causes of myopia?

A

genetic
can be caused by sleeping in a lighted room before the age of two, or accelerated by extensive close work activities, such as studying

409
Q

How is myopia treated?

A

bioconcave lenses

410
Q

Astigmatism

A

the curvature of the cornea is not uniform; causes light rays to be refracted to a different focus, blurring the retinal image

411
Q

How is an Astigmatism treated?

A

cylindric lenses

412
Q

Presbyopia

A

natural loss of accomodative capacity with age; inability to focus on objects at normal reading distance; usually occurs after 45

413
Q

What are treatments of Refractive Errors?

A 
glasses
contacts
surgery
topical atropine and pirenzepine for nearsightedness
rigid contact lenses at night
414
Q

What is Ultraviolet Keratitis?

A

ultraviolet burns of the cornea

415
Q

What causes Ultraviolet Keratitis?

A

use of sunlamp without eye protection

416
Q

What are symptoms of Ultraviolet Keratitis?

A

asymptomatic initially

after 6-12 hours - pain and severe photophobia

417
Q

How do you diagnose Ultraviolet Keratitis?

A

slit-lamp examination with fluorescein - shows diffuse punctate staining of both corneas

418
Q

How is Ultraviolet Keratitis treated?

A

binocular patching
instillation of 1-2 drops of 1% cyclopentolate (relieves discomfort)
recovers in 24-48 hours without complications

419
Q

What should NOT be prescribed with Ultraviolet Keratitis?

A

local anesthetics - delay corneal healing

420
Q

What is Chemical Conjunctivitis and Keratitis?

A

pain in the eyes after exposure to a chemical

421
Q

How is Chemical Conjunctivitis and Keratitis diagnosed?

A

slit-lamp - it can be difficult to assess severity of chemical burns

422
Q

How is Chemical Conjunctivitis treated?

A

copius irrigation with water, saline solution, or buffering solution
do NOT neutralize

Fundamentals of Medicine: EENT (6 decks)

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