Ophthalmology Flashcards
What is the hallmark of conjunctivitis?
Hyperemia of the conjunctival vessels.
What are the signs, symptoms, and treatment of ALLERGIC conjunctivitis?
Itching, bilateral, seasonal, long duration
Tx: vasoconstrictors or topical antihistamines/mast cell stabilizers
What are the signs, symptoms, and treatment of VIRAL conjunctivitis?
Preauricular adenopathy, highly contagious (look for affected contacts); clear, watery discharge
Tx: supportive, hand washing to prevent spread
What are the signs, symptoms, and treatment of BACTERIAL conjunctivitis?
Purulent discharge, classic in neonates
Tx: topical abx +/- systemic abx
What are the 3 common causes of neonatal conjunctivitis?
Chemical, Neisseria gonorrhoeae, and Chlamydia trachomatis
What causes chemical conjunctivitis? How do you recognize it?
Caused by silver nitrate (or erythromycin) drops that are given to all newborns to prevent gonorrhea conjunctivitis. The chemical conjunctivitis (with NO purulent discharge) appears within 12 hrs of instilling the drops and resolves within 48 hrs. It is always the best guess if the conjunctivitis happens in the first 24 hrs of life.
How can you distinguish gonorrheal from chlamydial conjunctivitis?
Gonorrheal (look for sxs of gonorrhea in mother) - extremely purulent discharge starting between 2 and 5 days after birth; tx = systemic ceftriaxone or cefotaxime
Chlamydial/inclusion (mother often w/o sxs) - mild-to-severe conjunctivitis beginning between 5 and 14 days after birth; tx = oral erythromycin for conjunctivitis or pneumonia
True or false: Conjunctivitis frequently causes loss of vision.
False. Other than transient blurriness (due to tear film debris) that resolves with blinking, conjunctivitis should NOT affect vision.
Define glaucoma. What are the risk factors for developing it? What are the two general types?
Ocular HTN (or elevated intraocular pressure, measured with a tonometer); effects include visual field defects and blindness. Risk factors: age >40, black race, positive family history 2 types: open-angle and closed-angle
Describe the physical findings of open-angle glaucoma. How common is it? How is it treated?
Painless and does not have acute attacks. Only signs are elevated intraocular pressure (usually 20-30 mmHg), a gradually progressive visual field loss, and optic nerve changes (increased cup-to-disc ratio on fundoscopic exam)
90% of glaucoma cases
Tx: beta blockers, prostaglandins, alpha-AdR agonists, carbonic anhydrase inhibitors, cholinergic agonists, laser therapy, surgery
How does closed-angle glaucoma present? What should you do if you recognize it?
Sudden ocular pain, seeing halos around lights, red eye, high intraocular pressure (>30 mmHg), nausea and vomiting, sudden decreased vision, and a fixed, mid-dilated pupil. OPTHALMOLOGIC EMERGENCY! Tx pt immediately with pilocarpine, oral glycerin +/- acetazolamide to breatk the attack. Definitive surgery (peripheral iridectomy) is used to prevent further attacks. *In rare cases, anticholingeric meds can trigger an attack in a susceptible, previously untreated pt.
How do steroids affect the eye?
Whether topical or systemic, steroids can cause cataracts and glaucoma. Topical ocular steroids can worsen ocular herpes and fungal infections. DO NOT give topical ocular steroids to a pt with a dendritic corneal ulcer that stains green by fluorescein (HERPES)!
Define ultraviolet keratitis. How is it treated?
Exposure to UV light can cause keratitis (corneal inflammation) with pain, foreign body sensation, red eye, tearing, and decreased vision. Pts have a history of welding, using a tanning bed or sunlamp, or snow-skiing (โsnow-blindnessโ). Tx with an eye patch (for 24 hrs) and topical antibiotic. You can reduce pain with an anticholinergic eye drop that causes paralysis of the ciliary muscle (cycloplegia).
What pediatric rheumatologic condition is commonly associated with uveitis?
Common in juvenile rheumatoid arthritis (esp. pauciarticular form)
What is the most common cause of painless, slowly progressive loss of vision?
Cataracts, esp. in the elderly. Tx is surgical removal of the affected lens(es) and replacement with an artificial lens.
What should cataracts in a neonate suggest?
TORCH (toxoplasmosis, other, rubella, CMV, and HSV) infection or inherited metabolic disorder (classic is galactosemia)
What changes in the retina and fundus are seen in diabetes?
Dot-blot hemorrhages, microaneurysms, neovascularization of retina
What changes in the retina and fundus are seen in HTN?
Arteriolar narrowing, copper/silver wiring, cotton-wool spots
Papilledema may be seen with severe HTN and should alert you to the presence of a HTN emergency.
What is the most common cause of blindness in patients under and over the age of 55?
Under 55 - diabetes
Over 55 - senile macular degeneration (look for macular drusen)