Ophthalmology Flashcards
- Episodic itching
- Hyperemia
- Tearing
- edema of the conjunctiva and eyelids
- condition usually subsides in 24 hours, even without treatment
Allergic conjunctivitis
- significant pain
- Miosis
- photophobia
- vision loss may be present
Anterior uveitis (iritis) which is inflammation of the anterior uveal tract, especially the iris
This is a severe form of ocular allergy. The most common symptoms are itching, tearing, thick mucus discharge, photophobia, and blurred vision. It can be differentiated from allergic conjunctivitis by more severe symptoms with a prolonged course, potential visual impairment due to corneal involvement, and thickening of the eyelids and surrounding skin
Atopic keratoconjunctivitis
In contrast to viral and allergic conjunctivitis, This will have a grossly purulent exudate and is likely to have more significant pain, erythema, and possibly fever
Bacterial conjuctivitis
This is an invasive infection of the globe (bacterial or fungal) and is due to disruption of the external surface of the eye (eg, trauma). It may show conjunctival irritation as well, but patients will usually have purulent haziness of the ocular contents and may have a layering-out of pus in the anterior chamber (hypopyon)
Endophthalmitis
This is infection of the fat and extraocular muscles surrounding the eye and is a medical emergency. Patients usually have erythema, edema, tenderness of the eyelids, often with impaired extraocular movement.
Orbital cellulitis
Symptoms of this are similar to those of allergic conjunctivitis but last longer (several days) and usually are preceded by typical nasopharyngeal symptoms. Most common in the late summer and fall and may occur in clusters or small epidemics
Viral conjunctivity (“pink eye”)
This is infection of the cornea related to HSV or varicella zoster. Patients typically have corneal vesicles, opacification, and/or dendritic ulcers
Viral keratitis
This is an acute inflammatory disorder of the eyelash follicle or tear gland and presents as an erythematous, tender nodule at the lid margin.
External hordeolum (stye)
Following resolution of external hordeolum (stye) some patients have a residual granulomatous nodule that regresses over time . . what is this called?
Chalazion
An external hordeolum is often due to infection with Staph aureus but can be sterile. initial treatment includes what?
warm compresses
This is an infection of the eyelid anterior to the orbital septum. It presents with fever and leukocytosis as well as erythema and edema of the eyelid and is treated with oral antibiotics (eg, doxycycline)
Preseptal cellulitis
A cataract is a vision-impairing opacification of the lens. Oxidative damage of the lens occurs with aging and leads to cataract formation. Risk factors for cataract include advancing age, diabetes, smoking, chronic sunlight exposure, and glucocorticoid use. Cataracts are usually bilateral, but patients may become symptomatic in one eye before the other. Patients usually report painless blurred vision, glare, and often halos around lights. What does ocular examination show?
- In early cataract formation may show a normal red reflex and retinal visualization
- As the cataract progresses, the red reflex is lost and retinal detail may not be visible
Management of cataracts?
- typically follow a slowly progressive course and treatment is indicated when loss of vision impairs activities of daily living.
- Definitive treatment is lens extraction with artificial lens implantation
This causes acute or subacute loss of vision. Ophthalmoscopy reveals a swollen disc, venous dilation, retinal hemorrhages, and cotton wool spots
Central retinal vein occlusion
This affects central vision. IT occurs in 2 primary forms: atrophic (“dry”), which causes slowly progressive, bilateral vision loss; and exudative/neovascular (“wet”), which causes unilateral, aggressive vision loss. Examination of the dry version show drusen and patchy depigmentation in the macular region
Macular degeneration
This is characterized by an insidious onset, with gradual loss of peripheral vision and consequent tunnel vision. Intraocular pressures are high. Ophthalmoscopic exam reveals cupping of the optic disc
Open-angle glaucoma
Describe the optic disc in open angle glaucoma
- Enlarged cup with cup:disc ratio > 0.6
- Increase in cup size over time
- Thinning of disc rim
- Pale disc (optic nerve atrophy)
This occurs unilaterally and suddenly. Patients often describe a “curtain falling in front of the eye” or obscuring of a part of the visual field. What is it and what does ophthalmoscopic exam show
- Retinal detachment
- Elevated, detached retina
Be overly suspicious for an intraocular foreign body in patients with high-velocity injuries (drilling, grinding, etc). If the initial pen light exam does not reveal any conjunctival and corneal abrasions or foreign bodies, what is the next step?
-Fluorescein application following a Wood’s lamp or, preferably, slit lamp examination
Age-related macular degeneration is usually seen in patients age > 50. It presents with progressive and bilateral loss of central vision. Peripheral fields and navigational vision (allowing patients to navigate around obstacles in their surroundings and maintain social independence) are classically maintained, although they may become impaired due to the development of cataracts. . . Age related macular degeneration results from degeneration and atrophy of what things?
- Central retina (macula)
- retinal pigment epithelium
- Bruch’s membrane
- Choriocapillaries
Ophthalmologic problems occur in approximately half of patients with advanced HIV infection. Retinitis can occur as a complication of opportunistic infections in AIDS patients. HSV/VZV and CMV can cause retinitis. . . Which is this. Initial symptoms are keratitis and conjunctivitis with eye PAIN, followed by rapidly progressive visual loss. Fundoscopy reveals widespread, pale, peripheral lesions and central necrosis of the retina
HSV/VZV . . Acute retinal necrosis syndrome
Ophthalmologic problems occur in approximately half of patients with advanced HIV infection. Retinitis can occur as a complication of opportunistic infections in AIDS patients. HSV/VZV and CMV can cause retinitis. . . Which is this? Typically PAINLESS, and funduscopy shows fluffy or granular retinal lesions located near the retinal vessels and associated hemorrhages. It does not usually cause initial conjunctivitis or keratitis
CMV retitinis
This presents with acute onset of severe eye pain and blurred vision associated with N/V. Examination shows a red eye with a steamy cornea and moderately dilated pupil that is NON-reactive to light
Acute Angle-closure glaucoma
This is usually caused by atheroemboli from the carotid arteries and causes temporary vision loss.
Amaurosis fugax
This is characterized by acute unilateral loss of vision, severe pain, and an afferent pupillary defect. It most commonly occurs in women age < 50 and is often an initial presentation of MS
Optic neuritis
Central retinal artery occlusion is emergently treated with what?
an ocular massage and high-flow oxygen administration
This typically presents with blurred vision, floaters, and photopsia (sensation of flashing lights). The major complications are vision loss (including blindness) and retinal detachment. Diagnosis is made by fundoscopy showing yellow-white, fluffy, hemorrhagic lesions along the vasculature
CMV retinitis
this is a common age-related decrease in lens elasticity that leads to difficulty with near vision. A history of a middle-aged individual who has to hold books at an arms length to read is classic
Presbyopia
A nonspherical cornea can lead to this, which typically presents with blurry vision both at a distance and up close
Astigmatism
With this, patients may have difficulty reading, but a history of difficulty with night vision or driving at night is more characteristic
Cataracts
Disease located in the peripheral retina is usually secondary to what disease
Diabetes
Treatment options in Bacterial conjunctivitis?
- Erythromycin ointment
- Polymyxin-trimethoprim drops
- Azithromycin drops
- Preferred agent in contact lens wearers: fluoroquinolone drops
Treatment options for Viral conjunctivitis
- Warm or cold compresses
- +/- Antihistamine/decongestant drops
Treatment options for Allergic conjunctivitis
- OTC antihistamine/decongestant drops for intermittent symptoms
- Mast cell stabilizer/antihistamine drops for frequent episodes
What are Olopatadine and Azelastine drops?
-Mast cell stabilizing agents . . used for allergic conjunctivitis
This is characterized by damage to one eye (the sympathetic eye) after a penetrating injury to the other eye. It is due to an immunologic mechanism involving the recognition of “hidden” antigens
Sympathetic ophthalmia
this presents with moderate pain and blurred vision. Cornea may be hazy. The anterior chamber shows flare and cells on slit lamp exam. The pupil is constricted with poor light response
Uveitis
This occurs due to blunt ocular trauma. Examination reveals central scotoma, retinal edema, hemorrhagic detachment of the macula, subretinal hemorrhage, and crescent-shaped streak concentric to the optic nerve. The usual complaint is blurred vision following blunt trauma
Choroidal rupture
This is characterized by a sudden painless loss of vision in one eye. Ophthalmoscopy reveals pallor of the optic disc, cherry red fovea, and boxcar segmentation of blood in the retinal veins
Central retinal artery occlusion
The initial stage of this is asmptomatic. Patients may later complain of decreased visual acuity. Neovascularization is the hallmark of this. The other findings are vitreous hemorrhage and macular edema. These changes may lead to retinal detachment
Proliferative diabetic retinopathy
A patient with a painful, red eye and opacification and ulceration has typical features of contact lens-associated keratitis. Most cases are due to what?
Gram-negative organisms such as Pseudomonas and Serratia
Contact lens-associated keratitis is a medical emergency and can lead to corneal perforation, scarring, and permanent vision loss if not addressed promptly. What is management?
In addition to removal and discarding of the contact lens, most patients require topical broad-spectrum antibiotics
This is a common cause of red eye and is distinguished by its localized or patchy distribution and generally mild associated pain and discharge. It may occur in association with rheumatoid arthritis and other autoimmune disorders, but many cases are idiopathic. It is usually self limited and does not affect vision or involve the cornea
Episcleritis
Patients using extended-wear contact lenses are at risk for both bacterial conjunctivitis and keratitis. Involvement of the cornea indicates which one?
-Keratitis . . The cornea is generally spared in uncomplicated conjunctivitis
This is usually caused by local trauma or valsalva maneuver. (eg, coughing, sneezing, vomiting). Patients will have a well-demarcated patch of extravasated blood beneath the conjunctiva. Most cases are benign and require no specific therapy
Subconjunctival hemorrhage
One of the earliest findings in this is distortion of straight lines such that they appear wavy. The grid test is frequently used to screen for these patients
Macular degeneration
An enlarged blind spot may be seen with this
Papilledema . . . increased ICP
What is the standard for diagnosis of Acute angle-closure glaucoma
- Gonioscopy
- Ocular tonometry can be helpful if urgent ophthalmological consultation is unavailable
Acute glaucoma is a medical emergency. Narcotics are used to control the pain. The increased intraocular pressure is reduced with what medications?
- Mannitol
- Acetazolamide
- Timolol
- Pilocarpine
Acute glaucoma is a medical emergency. Narcotics are used to control the pain. What medications should be avoided?
Mydriatic agents such as atropine . . . it can dilate the pupil and worsen the glaucome . . sometimes they can precipitate it
This is the first line of treatment for an acute episode of glaucoma and is administered IV . .it is an osmotic diuretic and works immediately
Mannitol
This is a carbonic anhydrase inhibitor that reduces further production of aqueous humor thus decreasing intraocular pressure in Acute glaucoma
Acetazolamide
This rapidly reduces intraocular pressure by opening the canals of Schlemm and allowing drainage of the aqueous humor. It is applied topically in treatment of Acute glaucoma
Pilocarpine
this is a beta blocker that decreases the intraocular pressure by decreasing production of the aqueous humor. It is administered topically
Timolol
This is characterized by corneal vesicles and dendritic ulcers
Herpes simplex keratitis
Most episodes of this occur in the elderly. It presents with fever, malaise, and a burning, itching sensation in the periorbital region. Examination reveals a vesicular rash in the distrubution of the cutaneous branch of the first division of the trigeminal nerve.
Herpes Zoster Ophthalmicus
This occurs after corneal injury in agricultural workers or immunocompromised patients. The cornea shows multiple stromal abscesses
Fungal keratitis
