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GME - Residency > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What are things you need to ask about in a HPI for red eye?

A

Pain
Foreign-body sensation
Itching
Discharge
Tearing
Photophobia
Visual disturbances
Diplopia
Recent illness / trauma
Contact lens use

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2
Q

What are some complications of contact lens use?

A

Corneal ulcer (don’t miss this)
Allergy to contact solution (can develop whenever)
Inappropriate fit

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3
Q

Review the components of the eye exam.

A

External inspection
Gazes conjugate
EOM intact
Pupils
Visual acuity
Visual fields
Pressures
Slit lamp
Fundoscopy

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4
Q

_____________ presents as hyperpigmented lesions on retina and are often found in screening exams done for other things.

A

Ocular melanoma

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5
Q

In which ocular cancers is enucleation the right approach?

A

When the tumor is large enough to be causing local problems or there is suspected extra-scleral involvement

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6
Q

What things do you need to assess in an eyelid laceration?

A

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.

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7
Q

Normal intraocular pressures are ________.

A

10 - 20 mm Hg

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8
Q

What is the normal path of the aqueous humor?

A

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.

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9
Q

True or false: central retinal artery occlusion causes painless vision loss.

A

True

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10
Q

_____________ presents with an increased prominence of the fovea.

A

Central retinal artery occlusion

This happens because blood flow to the retina is diminished and causes it to appear paler, thus highlighting the fovea.

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11
Q

What should you do when you suspect central retinal artery occlusion?

A

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.

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12
Q

Review the painless causes of vision loss.

A

Central retinal artery or vein occlusion
Occipital CVA
Retinal detachment
Vitreous hemorrhage
Amaurosis fugax
Macular degeneration

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13
Q

Review the painful causes of vision loss.

A

Acute angle-closure glaucoma
Optic neuritis
Corneal abrasion/ulcer
Endophthalmitis
Anterior uveitis
Iritis (traumatic or otherwise)
Temporal arteritis

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14
Q

Irrigation of the eyes is done with a __________ device that irritates with normal saline.

A

Morgan lens

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15
Q

Target pH of the eye is ______.

A

7.0 - 7.4

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16
Q

Which patients (that is, what PMH) makes hyphema high risk?

A

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.

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17
Q

What are three potential complications of post-septal cellulitis?

A
  • Vision loss
  • Meningitis
  • Cavernous sinus thrombosis
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18
Q

What causes pterygia?

A

UV light and dry climates

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19
Q

Chalazions result from obstruction of the _________ gland.

A

Meibomian

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20
Q

Corneal abrasion should be treated with ___________________.

A

erythromycin if no contact use and tobramycin (for PsA coverage) if a contact user

21
Q

The lacriimal gland is located in which aspect of the eye?

A

Lateral and superior

22
Q

The puncta are what?

A

Drainage ducts to the lacrimal duct

They are located in the medial aspect of the eye and there are a superior and inferior puncta.

23
Q

What test evaluates involvement of the puncta in an eyelid laceration?

A

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.

24
Q

Orbital fracture from blunt trauma usually occurs in which bone?

A

Maxillary bone (the floor of the orbit)

25
Q

Which muscle gets entrapped in orbital blowout fractures?

A

Inferior rectus

26
Q

Compare and contrast hordeola and chalazion.

A

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

27
Q

What is chemosis?

A

Swelling of the sclera

28
Q

What units is the pressure of the eye in?

A

mm H20

29
Q

Both CRAO and CRVO are painless. How will the histories and physicals be different?

A

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).

30
Q

Uthoff phenomenon is what?

A

Loss of vision with increased body temp, a finding of optic neuritis

31
Q

Review the mnemonic for monocular vision loss.

A

GO CART MTV
- Glaucoma
- Optic neuritis
- CRAO/CRVO
- Amaurosis fugax
- Retinal/vitreous detachment
- Trauma (open globe)
- Migraine
- Temporal arteritis
- Vitreous hemorrhage

32
Q

For acute angle closure glaucoma, what medication do you give last and why?

A

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.

33
Q

When does rebleeding typically occur in hyphema?

A

Within 72 hours

34
Q

What two treatments are first line for HSV keratitis?

A

Oral acyclovir and topical trifluridine

35
Q

In a CN III palsy from DM, the eye can’t move ____________.

A

medially and superiorly

36
Q

What is OCT?

A

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

37
Q

Review the nomenclature of left eye, right eye, and both eyes.

A

OS = left eye
OD = right eye
OU = both eyes

38
Q

What is CF vision?

A

Counting fingers vision

39
Q

What is fluorescein angiography?

A

Retinal diagnostics that is used to detect diabetic retinopathy and macular degeneration.

40
Q

Chalazion or hordeolum

Which is the more acute, infectious form?

A

Hordeolum (stye)

“HORdeolum are HORrible. CHalazion are CHill.”

41
Q

Homatropine is what type of agent?

A

Cycloplegic

42
Q

Which nerve is commonly damaged in inferior orbital blowout fractures?

A

Infraorbital nerve

Check for numbness and paresthesias of the cheek.

43
Q

What are the first two meds that need to be given after a diagnosis of glaucoma?

A

Topical beta-blocker and alpha-2 agonist (like timolol and brimonidine)

44
Q

True or false: topical antivirals have no role in the treatment of zoster ophthalmicus.

A

True

45
Q

When is the optimal time to remove a rust ring?

A

24-48 hours later

The epithelium stabilizes and becomes easier to remove in this time.

46
Q

Painless floaters and decreased visual acuity are signs of what?

A

Vitreous detachment

47
Q

What is the treatment for uveitis?

A

Ocular prednisolone

48
Q

What medication can you give to help treat hyphema?

A

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.

49
Q

What medication can you give to help treat hyphema?

A

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.

GME - Residency (111 decks)

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