Ophthalmology Flashcards
What are things you need to ask about in a HPI for red eye?
Pain
Foreign-body sensation
Itching
Discharge
Tearing
Photophobia
Visual disturbances
Diplopia
Recent illness / trauma
Contact lens use
What are some complications of contact lens use?
Corneal ulcer (don’t miss this)
Allergy to contact solution (can develop whenever)
Inappropriate fit
Review the components of the eye exam.
External inspection
Gazes conjugate
EOM intact
Pupils
Visual acuity
Visual fields
Pressures
Slit lamp
Fundoscopy
_____________ presents as hyperpigmented lesions on retina and are often found in screening exams done for other things.
Ocular melanoma
In which ocular cancers is enucleation the right approach?
When the tumor is large enough to be causing local problems or there is suspected extra-scleral involvement
What things do you need to assess in an eyelid laceration?
1) Involvement of the lid margin. If the lac crosses the margin it is high-risk for inversion/eversion deformity that can have lasting consequences.
2) Involvement of the canalicular system. If either the superior or inferior lacrimal puncta are involved then those need to be stinted open (by an oculo-plastics doctor) during repair)
3) Full thickness lacerations. Again, these are high-risk fro deformity and require an ophthalmologist.
Normal intraocular pressures are ________.
10 - 20 mm Hg
What is the normal path of the aqueous humor?
It is produced by the ciliary body with is posterior and lateral to the iris. It then travels between the iris and the lens to the anterior chamber. It goes anterior to the iris and is absorbed in the trabecular network.
True or false: central retinal artery occlusion causes painless vision loss.
True
_____________ presents with an increased prominence of the fovea.
Central retinal artery occlusion
This happens because blood flow to the retina is diminished and causes it to appear paler, thus highlighting the fovea.
What should you do when you suspect central retinal artery occlusion?
Consult ophthalmology, massage the orbits (to attempt to dislodge the clot), and give timolol or acetazolamide to reduce ocular pressure which increases the pressure gradient and can dislodge the clot.
Review the painless causes of vision loss.
Central retinal artery or vein occlusion
Occipital CVA
Retinal detachment
Vitreous hemorrhage
Amaurosis fugax
Macular degeneration
Review the painful causes of vision loss.
Acute angle-closure glaucoma
Optic neuritis
Corneal abrasion/ulcer
Endophthalmitis
Anterior uveitis
Iritis (traumatic or otherwise)
Temporal arteritis
Irrigation of the eyes is done with a __________ device that irritates with normal saline.
Morgan lens
Target pH of the eye is ______.
7.0 - 7.4
Which patients (that is, what PMH) makes hyphema high risk?
Sickle cell disease and trait
Sickled cells impair blood cells leaving the trabecular network. People with both trait and sickle cell disease are at high risk of vision loss from hyphema.
What are three potential complications of post-septal cellulitis?
- Vision loss
- Meningitis
- Cavernous sinus thrombosis
What causes pterygia?
UV light and dry climates
Chalazions result from obstruction of the _________ gland.
Meibomian
Corneal abrasion should be treated with ___________________.
erythromycin if no contact use and tobramycin (for PsA coverage) if a contact user
The lacriimal gland is located in which aspect of the eye?
Lateral and superior
The puncta are what?
Drainage ducts to the lacrimal duct
They are located in the medial aspect of the eye and there are a superior and inferior puncta.
What test evaluates involvement of the puncta in an eyelid laceration?
Fluorescein
You put fluorescein on the eyeball and look for fluorescein in the eyelid laceration. If you see uptake then you know the puncta is involved.
Orbital fracture from blunt trauma usually occurs in which bone?
Maxillary bone (the floor of the orbit)
Which muscle gets entrapped in orbital blowout fractures?
Inferior rectus
Compare and contrast hordeola and chalazion.
Hordeola (aka stye):
- Eyelash folliculitis
- Usually occurs at the base of eyelashes on the lower lid
- Painful
- Treat with warm compresses
Chalazion:
- Blocked Meibomian gland
- Usually found above the eyelashes of the upper lid
- Painless
- Treat with warm compresses
What is chemosis?
Swelling of the sclera
What units is the pressure of the eye in?
mm H20
Both CRAO and CRVO are painless. How will the histories and physicals be different?
CRAO presents with amaurosis fugax – complete loss of vision – and on exam there will be a pale macula.
CRVO presents with blurring of vision but not complete loss of vision and on exam there will be diffuse hemorrhages and disc edema (the “blood and thunder” retina).
Uthoff phenomenon is what?
Loss of vision with increased body temp, a finding of optic neuritis
Review the mnemonic for monocular vision loss.
GO CART MTV
- Glaucoma
- Optic neuritis
- CRAO/CRVO
- Amaurosis fugax
- Retinal/vitreous detachment
- Trauma (open globe)
- Migraine
- Temporal arteritis
- Vitreous hemorrhage
For acute angle closure glaucoma, what medication do you give last and why?
Pilocarpine
It is a miotic agent. In glaucoma, the anterior pressure is so high that the muscles of the iris are ischemic. Giving the other agents (timolol, acetazolamide, and steroids) helps to relieve the pressure and make pilocarpine work.
When does rebleeding typically occur in hyphema?
Within 72 hours
What two treatments are first line for HSV keratitis?
Oral acyclovir and topical trifluridine
In a CN III palsy from DM, the eye can’t move ____________.
medially and superiorly
What is OCT?
Ocular coherence tomography
This is a non-invasive imaging test that takes cross-sectional imaging of the retina. Used to diagnose diabetic retinopathy and macular degeneration (among other things).
OCT think Ocular CT
Review the nomenclature of left eye, right eye, and both eyes.
OS = left eye
OD = right eye
OU = both eyes
What is CF vision?
Counting fingers vision
What is fluorescein angiography?
Retinal diagnostics that is used to detect diabetic retinopathy and macular degeneration.
Chalazion or hordeolum
Which is the more acute, infectious form?
Hordeolum (stye)
“HORdeolum are HORrible. CHalazion are CHill.”
Homatropine is what type of agent?
Cycloplegic
Which nerve is commonly damaged in inferior orbital blowout fractures?
Infraorbital nerve
Check for numbness and paresthesias of the cheek.
What are the first two meds that need to be given after a diagnosis of glaucoma?
Topical beta-blocker and alpha-2 agonist (like timolol and brimonidine)
True or false: topical antivirals have no role in the treatment of zoster ophthalmicus.
True
When is the optimal time to remove a rust ring?
24-48 hours later
The epithelium stabilizes and becomes easier to remove in this time.
Painless floaters and decreased visual acuity are signs of what?
Vitreous detachment
What is the treatment for uveitis?
Ocular prednisolone
What medication can you give to help treat hyphema?
Cycloplegiacs (like atropine drops)
The thought is that these help decrease bleeding from relaxing the iris. The blood vessels that cause hyphema are usually in the iris, so preventing them from getting stretched allows them to heal.
What medication can you give to help treat hyphema?
Cycloplegiacs (like atropine drops)
The thought is that these help decrease bleeding from relaxing the iris. The blood vessels that cause hyphema are usually in the iris, so preventing them from getting stretched allows them to heal.
