Ophthalmology Flashcards
Give a condition that correspond to following eye condition:
- Coloboma
- Dislocated Lens
- Aniridia
- Glaucoma
Coloboma= CHARGE
- defect in iris
Dislocated Lens= Marfan’s
Aniridia= WAGR absent iris (aniridia), Wilm, Gonadoblastoma, Retardation
Glaucoma= NF1, Sturge Weber Syndrome
Triad of symptoms for glaucoma?
Tearing
+ Photophobia
+ Blepharospasm (involuntaring eyelid closing)
21 mon. left eye conjunctivitis w/ d/c. Normal examination. 36h after cipro exam the same. Next step?
Refer to ophtho.
- if pt doesn’t respond to warm compress + topical ABX x 1-2d= ophtho referral.
Note: fucidic acid= steroid should be prescribed by non ophtho b/c high risk for severe complication.
What are red flags w/ conjunctivitis that suggest ophtho referral?
- *contact lens involved
- severe purulent d/c
- *vision loss
- severe pain
- severe photophobia
- *corneal involvement
- conjunctival scar
- cutaneous-conjunctival (SJS)
- *HSV
Key to amblyopia treatment?
Patch good eye.
+/- Sx
What is amblyopia?
Defect in vision
- that cannot be explained by refractive error
When do you refer strabismus (misalignment like eso or exotropia) to ophtho?
- if > 4 month
- fixed deviation
- decreased visual acuity
Child with right esotropia but normal corneal reflex. What is the reflex?
Pseudostrabismus
3 month old w/ crusty d/c intermittently. Tx?
Likely nasolacrimal duct obstruction.
Tx: massage 2-3X daily
+ cleansing lids warm water
+/- topical Abx mucopurulent drainage
+/- ophthal ointment to lid if macerated
T or F: BB w/ dacrostenosis may develop dacrocystitis.
True.
T or F: BB with dacrostenosis is always present at birth.
False.
Not always true. Symptoms at birth also then depend if partial or complete block.
3 month old with seromucoid d/c from 1 eye. What do you do?
Reassure.
Like nasolacrimal duct obstruction.
Risk factors for nasolacrimal duct obstruction?
- *T21
- *CHARGE
- Goldenhar syn
- Branchiooculofacial syndrome
List two complications of nasolacrimal duct obstruction:
- Dacrocystitis (acute infection of sac)
- Periorbital cellulitis
- Pericystitis
T or F: Dacryostenosis resolve by 2 y.o.
False.
Resolve by 1 y.o.
List 3 causes of leukocoria (white reflex)?
- Cataract
- Retinoblastoma
- Toxocariasis
- Chronic retinal detachment
- Coats Dx (abN retinal vasculature)
- Advanced retinopathy of prematurity
Which of the following is true about anisocria (unequal size pupils) in child w/ otherwise normal P/E.
- unequal pupils seen in 25% of N kids
- AR trait
- larger pupil abN
- larger pupil will have abN shape
Unequal pupils seen in 25% of normal children.
- typical AD
- smaller or larger pupil could be abN
List three aetiologies for anisocoria (unequal pupils):
- Synechiae (adhesion)
- Congenital iris defect (coloboma etc.)
- Symph or parasymph defect
4 Horner (PAM- ptosis, anhidrosis, mitosis)
Which sport is most common cause of eye injury in Canada:
- baseball
- hockey
- soccer
- golf
- javelin
- baseketball
Hockey
or Basketball
When is re-bleeding most likely to occur with hyphema:
4 days
usually 3-5 d after initial bleed
List 2 steps in immediate management in hyphema.
- Bed rest
- HOB 30 degree
- Shield (without patch) on affected eye
- Cycloplegic agent
- Topical or systemic steroids
- Call ophtho!
List two complications if hyphema not treated correct
- Rebreeding
- Glaucoma
- Corneal blood staining
Define a hyphema:
bleeding in anterior chamber
T or F: most common cause of hyphema is juvenile xanthogranuloma (non langerhans cell histiocytosis)
False. Rare Cause.
Most= trauma
- blunt or perforating injury
T or F; all hyphema to be evaluated and managed by ophtho.
True
Periocular infantile hemangioma. List two things you would do in immediate management.
- Ophtho consult
- Topical beta blocker
- Intralesional steroid
- +/- Sx excision
5 y.o. M with serious mucoid d/c from left eye. No periorbital edema or red. Mom and bro had same thing 1 week ago. Tx?
Reassure.
- likely viral
Contact lens conjunctivitis. Management?
Referral to ophtho
Most serious condition associated with contact lens wearer?
Infectious keratitis
- bacterial
- symptom in 24h
- conjunctivitis
- poor vision
- pain
- topical Abx + Ophtho
List two steps in managing baby with corneal abrasion seen on fluorescein dye.
- Topical ABX 4X/day x 3-5 d
i. e. erythromycin, Trimethoprim-polymyxin B - Pain med
i. e. NSAID
i. e. large abrasion give cycloplegia agent
- Ophtho F/U
PATCHING not recommended.
+/- tetanus (only for penetrating trauma)
T or F: you should patch an eye with corneal abrasion.
False.
- BUT do you want to avoid squeezing and rubbing
Which is T regarding retinal hemorrhage:
- need to dx abusive head trauma
- occur in vag delivery
- do not occur after C/S
- always associated w/ trauma
- can happen with CPR
Occur in vag delivery (25% higher if vacuum assist)
- can happen w/ C/S
- not needed for abusive head trauma dx
- can be atraumatic
- rare for CPR to be cause
T or F: non traumatic causes of retinal hemorrhage go away within 6-8 weeks of age.
True.
List 3 causes of retinal hemorrhage:
- child birth
- abusive head trauma
- bleeding dx (hemophilia, vitamin K deficiency, vWF)
- metabolic (*glutaric aciduria type 1, galactosemia)
- cerebral malaria, meningitis
- bleeding dx (hemophilia, vitamin K deficiency, vWF)
Name the eye condition associated w/: toxoplasmosis
Chorioretinitis
white, black, grey cloud
Name the eye condition associated w/: Abusive head trauma
Retinal hemorrhages
red ill-defined areas
Name the eye condition associated w/ late ROP
tortuous vessels
thick, squiggly
Name the eye condition associated w/: Tay-sachs disease
Cherry red spots
flame red with yellow cloud around
Name red flags P/E for orbital cellulitis:
- *relative afferent pupillary defect (due to optic nerve defect)
- *visual acuity change
- *ophthalmoplegia (wk muscle = EOM)
+/- diplopia - *pain w/ EOM
- *proptosis
- chemosis
When do you consider Sx approach for blocked nasolacrimal duct obstruction?
If approaching 1 year.
Consider referral after 9 mo. as most resolve by 1 y.o.
- can do probe in office= 90% cure rate
Which nerves innervate eye movements?
All CN3 EXCEPT LR6-SO4 (lateral rectus CN6) (superior oblique CN4)
Child with CN 7 palsy will typically:
- be unable to open
- be unable to close
- poor corneal sensation
- reduced tearing
- poor vision acuity
Unable to close affected eye
List 5 causes of Ptosis:
Ptosis= lid doesn’t elevate
- congenital: *dystrophic levator muscle (no eye lid crease)
- *hemangioma
- trauma
- *muscular dystrophy
- myasthenia gravis
- *CN 3 palsy (ptosis + exotropia)
- *Horner (PAM)
- Idiopathic
T or F: you can have normal vision in orbital cellulitis.
True.
If abN= orbital.
but can be Normal.
What is the clear divider between orbital + periorbital cellulitis?
Orbital septum
What are common causes of orbital versus periorbital cellulitis
Orbital: sinus infection.
+ unwell, fever, painful EOM, red eye.
Preseptal/Periorbital: lid wound, bite.
+ no fever typically w/ white eye.. Full EOM. no sinus opacification.
Is blepharitis or chalazoin associated with corneal scaring complication?
Blepharitis.
T or F: most causes of nasolacrimal duct obstruction resolve spontaneously.
True
R pupil < L in healthy 3 month old. Which suggest Horner?
a. Severe right ptosis
b. right iris lighter than left
c. mild R proptosis
d. optic disc edema R
e. limited abduction R eye
Horner= PAM
- ptosis (mild though because Horner affect sympathetic but CN 3 does a lot of work so only drop 1-2mm)
- anihidrosis
- miosis
** sympathy also drive colour of iris.
So answer= B. iris lighter on R than L
T or F: bilateral retinal hemorrhage is pathognomonic for abusive head trauma.
False.
No pathognomonic.
But multiple b/l retinal hemorrhage raise concern.
Who is at risk of ROP:
- GA < 31 wk GA
2. OR BW < 1250 g
What are kids with ROP at risk of later?
Strabismus
Amblyopia
Refractive Error
*see them @ 1 y.o.
If good- community check @ 3-5 y.o.
What is the most common intraocular CA of childhood?
Retinoblastoma.
Cause leukocoria.
T or F: you can electively refer ophtho for abN red reflex.
False.
EMERGENT!
Obese teen with new h/a. AbN fundoscopy. Dx? other Symp?
Papeilledema.
Likely idiopathic intracranial HTN.
Symp:
- transient visual obstruction
- horizontal diplopia
- pulsatile tinnitus
- N/V
“My baby only opens their eyes at night”
Congenital glaucoma
Pituitary Mass cause what visual defect?
Bilateral hemianopia.
B/L outter halves gone.
Best test to confirm dx of “esotropia”
Cover test
Myopia means what?
My My= i can see up close. but can’t see far
-= Near-sighted.
T or F: constant nystagmus can be physiologic.
False.
- Constant mvmt= NOT normal.
- suggest benign congenital dx, low vision, structural lesion etc.
T or F: it’s normal to still have physiologic strabismus at 4 months.
False.
3-4 month: eyes properly aligned. NO strabismus. Fix and follow well.
Name some red flags for ophtho:
- strabismus
- visually disinterested +/- stare at bright light
- forcefully rub or poke eye
- nystagmus constantly
- sunsetting
Q: 2 y.o. F. Considering JIA. Which dx helpful to confirm:
a. b/l episcleral injection near limbus (“ciliary flush”)
b. b/l photophobia
c. prominent blepharitis
d. mild enlargement of globes
e. mild WBC rxn of anterior chamber of both eyes
E. Mild WBC rxn of anterior chamber of both eyes.
JIA= Chronic uveitis
- asymptomatic (no pain, no red)
- Slit Examine
- Tx early
- No Tx= blind
