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Mandatory Selectives > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Eye vitals

A
  1. Visual acuity
  2. Intraocular pressure (10-21)
  3. Pupils
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2
Q

Red flags

A
  1. Decreased vision
  2. Haloes
  3. Pain
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3
Q

Pin Hole occluder

A

Focuses light - this stops defects (errors of refraction)
USE = differentiate refractive errors vs other visual defects
IMPROVES = cornea or lens
NO IMPROVEMENT = retina or optic nerve

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4
Q

PERRLA

RAPD

A

Pupils equal, round, reactive to light and accommodation

Relative afferent pupillary defect

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5
Q

7 step approach to eye trauma

A 
Mechanism of injury
(blunt, sharp, foreign body, chemical - alkali worst than acid, because it goes right through vs. acid coagulates the tissue)
Visual Acuity
Pupils
Cornea & Conjunctiva
Fluorescein 
Anterior chamber
Iris
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6
Q

Visual acuity

A

Chart – fingers – movements – light perception

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7
Q

Ocular trauma red flags

A 
Loss of vision
Loss of red reflex
Flat anterior chamber*
Tear shaped pupil*
Uveal prolapse*
**last 3 are clinical signs of globular rupture
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8
Q

Cornea and Conjunctiva

A

Fluorescein stain

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9
Q

Ciliary flush

A

= circular pattern
Causes:
Traumatic iritis
Hyphema

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10
Q

Corneal laceration

A

Whitish lesion
“Tearing”
Requires glue or suturing

If underlying sclera normal
Not serious
No suturing

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11
Q

Retrobulbar hemorrhage

A
  • Acute proptosis**
  • Lid Swelling
  • Often limited EOMs
  • Pain
  • Loss of vision
  • Loss of pupillary reaction
  • Urgent treatment required to save optic nerve
  • Topical and systemic IOP lowering meds
  • Canthotomy and cantholysis
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12
Q

Hyphema, Microhyphema

A
  • *blunt trauma
  • Limit activity
  • HOB elevated allows RBCs to settle inferiorly and clot; prevents further clogging of trabecular meshwork
  • No ASA or NSAIDs
  • Shield
  • Ophthalmologist to monitor IOP and control inflammation with steroids
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13
Q

Ruptured globe

A
  • Don’t push on the globe
  • Do not take an IOP!!
  • Shield
  • NO patch
  • Treat nausea and vomiting
  • Limit activity
  • Get patient to OR
  • Remove non viable tissue
  • Gently reposition prolapsed tissue
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14
Q

Non-traumatic red eye

A
  1. Infectious
  2. Inflammatory
  3. Other
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15
Q

Infectious red eye

A

Infectious:

  • Conjunctivitis
  • Viral
  • Bacterial
  • Keratitis (cornea)
  • Contact lens related
  • Bacterial
  • Viral (Herpes Simplex)
  • Cellulitis
  • Orbital
  • Periorbital
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16
Q

Inflammatory red eye

A

Iritis
Episcleritis
Scleritis
Blepharitis

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17
Q

Other red eye

A

Subconjunctival hemmorrhage
Allergic conjunctivitis
Acute glaucoma
Spontaneous erosion

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18
Q

DO NOT MISS RED EYE

A
  • infectious keratitis
  • orbital cellulitis
  • acute glaucoma
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19
Q

Bacterial conjonctivitis

A
  • Sx: tearing, foreign body sensation, stinging, photophobia, blurry vision
  • S: discharge (purulent)
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20
Q

Neonatal conjunctivitis

A 
During first month of life
*Gonococcus (within 24hrs); ceftriazone IV
*Chlamydia (1-2w); erythromycin PO
Erythromycin ointment as prophylaxis
Culture and systemic therapy required
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21
Q

Chlamydial Conjunctivitis

A

Sexually active adolescents/adults
Unilateral
Follicular reaction
Chronic (>3 weeks)
MicroTrak kit
Oral azythromycin (1g x1) or doxycycline (100mg BID)
*Chlamydia sensitive to tetracyclines and macrolides

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22
Q

Bacterial Conjunctivitis: Organisms

A
  • Children
  • Hemophilus
  • Strep Pneumoniae
  • Staphylococcus
  • Adults
  • Strep Pneumoniae
  • Staphylococcus
  • Hemophilus
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23
Q

Viral conjunctivitis

A

Very common, Adults and children

  • Symptoms: Tearing, Foreign body sensation, Photophobia, Blurry Vision
  • Signs: Discharge, Watery, Follicles, Pre-auricular node, Submandibular & cervical

Ask About: Red eye contact, URTI symptoms

Etiology: Adenovirus; hx of rhinorrhea, sore throat (pharyngitis); unilateral – bilateral

Investigations: None required

Therapy: No specific therapy, Cool compresses, Artificial tears

Very contagious, Hand washing, Stay away from work until asymptomatic

24
Q

Infectious Keratitis

A

Symptoms: Pain, Reduced Vision

Signs: White corneal infiltrate (ulcer), Flourescein uptake (epi defect), Discharge, Anterior Chamber Reaction

Ask About: Contact lens use

Etiology: Staphylococcus, Pseudomonas (Contact lens wearer), Strep. Pneumo

Associations: Lid or Conjunctival Disease, Sterile immunologic infiltrate

Large/Central Ulcer: Urgent referral (same day), Culture, Fortified Drops, Tobra / Vanco

Small/Peripheral Ulcer: Next day referral, Fluoroquinolone monotherapy, Moxifloxacin, No culture required

25
Q

Cellulitis

A

Agents: staph and strep (hemophilus in non-immunized children)
When in doubt: CT to differentiate from orbital cellulitis

Normal: Vision, Position, Movement

26
Q

Periorbital Cellulitis

A 
Management
Oral antibiotics (mild): Amox/Clav 
IV antibiotics (moderate-to-severe):
Pip-Tazo + Vanco
27
Q

Orbital Cellulitis

A

Vision- and potentially life-threatening

Etiology: Sinusitis (MC), Trauma / surgery, Vascular extension (i.e. systemic bacteremia), local contiguous spread from periorbital cellulitis

Decreased vision, decreased ROM of the eye, afferent pupillary defect
*MAIN ETIOLOGY = SINUSITIS

28
Q

Orbital Cellulitis (signs, mangement)

A

Signs: Blurred vision, Proptosis, Limited Ocular Mobility / Diplopia, Pain, Chemosis, Sinus congestion, toothache, Systemically unwell

Management: Admission Ophthalmology, ENT

IV Antibiotics: Pip-Tazo + Vanco (MRSA coverage)

29
Q

PHENYLEPIPHERINE

A

SUPERFICIAL VESSELS INFLAMMAED + PHENYL = BLANCHED IN EPISCLERITIS

PHENYL AND NO BLANCHING = SCLERITIS
SCLERITIS 50% SYSTEMIC ETIOLOGY (RHEUMATOOID ARTHRITIS, LUPUS) ** MOST LIKELY HAVE SECONDARY ETIOLOGY
TB, SYPHILLIS, SARCOROID

30
Q

Episcleritis

A

Symptoms: Asymptomatic or mild discomfort, Mild photophobia, Irritation

Signs: **Sectorial redness, Superficial episcleral injection, Localized tenderness

Etiology: Immune-mediated

Treatment: Oral/Topical NSAIDS

31
Q

Scleritis **PAINFUL

A

Symptoms: Pain, Dull, Achy, Deep, Boring, Photophobia, Tearing

Signs: Bluish red injection, Deeper structures, Nodules, Necrosis
PAIN WAKE YOU UP AT NIGHT? YES = MORE LIKELY TO BE SCLERITIS

Etiology: Immune-mediated
Associated Diseases: 30-60% Collagen Vascular, Rheumatoid arthritis, Lupus
Wegener’s

Treatment: Topical steroids
± Oral/Topical NSAIDS
± Oral steroids
± Oral immunosuppressants

32
Q

Acute Iritis

A

Symptoms: Pain, Redness, Photophobia

Signs: Tenderness, Miosis, 
Keratic Precipitates
- WBC’s on corneal endothelium
Posterior Synechiae
- Iris-Lens adhesions
ANTERIOR CHAMBER CELLS/FLARE

Management
Cycloplegia
Referral for steroid therapy
*Think HLB-27 , SERO-NEGATIVE ARTHROPATHIES , ANKYLOSPONDYLAR, IBD

33
Q

Acute glaucoma

A 
Significant pain
Ocular
Headache
Nausea and Vomiting
Ocular pressure is transmitted centrally!
Decreased Vision
Colored haloes

Signs: Fixed mid-dilated Pupil, Steamy Cornea, Shallow anterior Chamber, ELEVATED IOP

Mechanism: Pupillary Block

Treatment: Pilocarpine 1%, Pressure Lowering Medications Topical- Oral -I.V.

Definitive Management: Laser Iridotomy

34
Q

8 steps

A
  1. Symptoms
  2. Visual Acuity
  3. Pupils
  4. Conjunctiva
  5. Discharge
  6. Fluoroscein
  7. Cornea
  8. Anterior chamber
35
Q

Vision (normal vs decreased)

A 
*Normal Vision
Conjunctivitis
 viral
 bacterial
 allergic
Subconj. Hemorrhage
Periorbital Cellulitis
*Decreased Vision
Keratitis
Acute Glaucoma
Orbital Cellulitis
 (late stage)
Iritis – less marked
36
Q

Pupils mid-dilated and poorly reactive

A

Acute glaucoma

37
Q

Pupils constricted and poorly reactive

A

Iritis

38
Q

Pupils constricted and poorly reactive

A

Iritis

possible synechia - iris stuck to cornea or lens

39
Q

Discharge (clear and purulent)

A 
*Clear
Corneal Irritation
Keratitis
Erosion
Glaucoma
Allergy
Viral Infection

*Purulent
Bacterial Infection

40
Q

Fluorescein Uptake

A
  • Erosion

- Herpetic Keratitis (dendritic)

41
Q

Fluorescein Uptake

A
  • GLOWS GREEN*
  • Erosion
  • Herpetic Keratitis (dendritic; tree branch pattern)
  • infectious keratitis = has underlying opacity
42
Q

Localized Opacity

in corna

A

Cornea ulcer
Corneal infiltrate
*Consult

43
Q

Anterior chamber

  • cells and flare
  • pus (hypopyon)
  • shallow
A

Cells and flare: iritis
Pus (hypopyon): corneal ulcer
Shallow: acute glaucoma

44
Q

Anti-glaucoma agents

A
  1. Decrease production of aqueous: beta blocker (timolol), carbonic anhydrase inhibitors (dorzolamide)
  2. increase outflow of aqueous: prostaglandin analogues (latanoprost), miotics (pilocarpine)
  3. Both: alpha agonist (brimonidine)
45
Q

globe rupture or prolapsed iris or intraocular foreign body

A

Tear shaped pupil

46
Q

DO NOT MISS

A
  1. Keratitis (corneal inflammation); contact lens, bacterial, viral (herpes simplex)
  2. Orbital cellulitis; proptosis, vision changes, RAPD
  3. Acute glaucoma
47
Q

DO NOT MISS

A
  1. Keratitis (corneal inflammation); contact lens, bacterial, viral (herpes simplex; tx: acyclovir)
  2. Orbital cellulitis; proptosis, vision changes, RAPD
  3. Acute glaucoma
48
Q

Gono conjonctivitis

A
  • *hyperpurulent + hyperacute
  • *urgent referral

Mangament:

  • Topical, IV Ceftriaxone, saline irrigation
  • Oral Azithromycin or doxycline = if chlamydial co-infection
49
Q 
Pre-septal vs. orbital
Etiology
Systemic S&S
Ocular Mobility
Vision
Eye position
Pain w/eye movement
Conjunctival injection
Chemosis
RAPD
Lid Edema
A 
Preseptal
Etiology: trauma, conjunctivitis, dacryocystitis, chalazion
(vs. sinutis)
Systemic S&S: No* (vs. yes)
Ocular Mobility: Normal* (vs. abnormal)
Vision: Normal* (vs. decreased)
Eye position: Normal* (vs. proptosis)
Pain w/eye movement: NO* (vs. Yes)
Conjunctival injection: Absent (vs. present)
Chemosis: mild or absent (vs. marked)
RAPD: no (vs. maybe seen)
Lid Edema: mod-sev (vs. severe)
50
Q

Uveitis

A

Iris, ciliary body (under iris), choroid (under retina)
Etiology
1. Autoimmune
- HLAB27: PAIR; psoriatic arthritis, ankylosing spondylitis, IBD, reactive arthriti
- NON-HLAB27: JIA
2. Infectious
- Syphilis, lyme, toxocoplasmosis, TB, HSV, Herpes zoster
3. Other
- sarcoid, trauma, large abraison

51
Q

Signs of anterior uveitis

A
  • tenderness of eye
  • ciliary flush (conjunctival injection around LIMBUS - edge of iris)
  • hypopyon (WBC collection ant chamber) - can affect visual acuity
  • anterior chamber cells
  • flare (smoke) in ant chamber
  • keratic precipatic (cells) white dots on cornea (cells phagocytosed by endothelial cells)
  • posterior synechia - iris stick to lens –> distorted pupil, can lead to acute glaucoma, treatment: cycloplegic - atropine
52
Q

Glaucoma classification

A

Open angle - dysfunction of trabecular meshwork (water cannot leave); painless, chronic vision loss (peripheral)
RF primary: increased age, african, high IOP, family hx
RF secondary: trauma (hyphema), inflmmation, steroids (dammage meshwork), neovascularization (DB)

Angle-closure - iris and lens stop fluid from flowing; fluid keeps being made; pressure build behind iris
RF: older, female, Chinese or inuit, hyperope (far sighted)
Key features: color of cornea = hazy + glint = distorded

  • *GLAUCOMA = OPTIC NEUROPATHY associated with HIGH INTRAOCULAR PRESSURE (not defined by high pressure)
  • can have normal pressure with nerve damage can still be glaucoma = normal tension glaucoma
53
Q

Ambylopia

A

Abnormal visual development → decreased visual acuity

visual stimulation is highly important for maturation of the visual cortex

54
Q

Ambylopia classfication

A
  • strabismus (most common): leads to the generation of images that cannot be fused properly, image generated by one eye is suppressed by the visual cortex
  • refractive error (second most common): leads to differences in image clarity
  • visual deprivation : e.g., cataracts
55
Q

strabismus direction

A
  • direction of the eye that is NOT fixed on target
  • esotropia: inwardly deviated “crossed eyes”
  • exotropia: outwardly deviated “walled eyes”
  • hyper; up
  • hypo; down
56
Q

Stye (hordeolum)

A

Definition: Acute, purulent inflammation of the glands or eyelash follicles of the eyelid.

most commonly Staphylococcus aureus, which gain access to meibomian glands (internal hordeolum) or eyelash follicles or glands of Zeis (external hordeolum, or stye), leading to an acute, purulent, painful inflammation of the eyelid.

57
Q

Chalazion

A

Definition: Firm, nontender nodular lesion of the eyelid resulting from obstruction and subsequent chronic granulomatous inflammation of a Zeis or meibomian gland.

Mandatory Selectives (2 decks)

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