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Ophthalmology Flashcards

1
Q

Eyelids are AKA ?

What is the two functions?

A

Palpebrae

Protect eye
Aid lacrimal- spread new/drain old tears

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2
Q

What type of glands do the eyelids hold?

What is the name of the space between the upper and lower lid?

A

Meibomian

Palpebral fissure

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3
Q

Upper and lower eye lids meet on each side of the eye at the ?

What muscle closes the eye and what nerve innervates it?

A

Canthus

Orbicularis oculi; CN7

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4
Q

What muscle opens the upper eyelid and what nerve innervates it?

What does Mueller’s muscle do and what nerve innervates it?

A

Levator palpebrae superioris: CN3

Inserts on tarsus plate to
assist opening BOTH lids during fear/surprise; Sympathetic ANS

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5
Q

What are the 3 tunics of the globe?

? is the front window of the eye and what is its major role?

A

Fibrous- Sclera Cornea
Vascular- Iris Ciliary Choroid
Nervous- Retina

Cornea
Major refractive surface

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6
Q

Define Limbus

What type of cells provide color to the iris and what is the function?

A

Sclera/Cornea junction

Melanin
Light regulation into eye

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7
Q

Define Pupil and what innervates it?

Define Conjunctiva and what are the two parts

What is the name of the junction where the two conjunctiva meet?

A

Circular opening in iris
Sphincter: P-ANS
Dilator: S-ANS

Clear membrane
Palpebra: inside of eyelid
Bulbar: covers sclera

Fornix

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8
Q

People w/ blue eyes have all of the melanin w/in the iris located ?

People w/ brown eyes have all of the melanin located ?

A

Behind pupil

Back and front of pupil

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9
Q

What is the function of the ciliary body?

What is the function of the ciliary muscle?

What type of ciliary movements allow for near/far vision?

A

Produce aqueous humor

Change zonular tension, control lens

Contraction= less tension, fatter lens (accomodation)
Tension= taught, thinner lens (distance vision)
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10
Q

Define Choroid

What is its function?

A

Vascular pigmented layer between sclera/retina

Supplies blood to outer retina

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11
Q

Where is the anterior chamber and what does it contain?

Where is the posterior chamber and what is it filled with

A

Between cornea/iris
Contains aqueous humor and drainage system

Behind iris/front of vitreous
Filled by aqueous humor

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12
Q

Lens has ? shape and suspended by ?

What ‘responsibility’ does it have?

A

Biconvex
Zonules

1/3 of refractive power

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13
Q

What are the four components of the vitreous humor?

Retina is AKA and is the ? of the eye

A

Collagen
Soluble proteins
Hyaluronic acid
Water

Fundus
Neural lining

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14
Q

How thick is the retina?

What is contained within it and how many per eye?

A

10 layers, 9 are transparent

Photoreceptor- send signals to brain
Cones: color/acuity, 6M
Rods: black/white, night, 120M

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15
Q

Where is the macula located?

What is its function?

What structures does it contain?

A

Posterior pole of retina
Central fovea depression

Fine/central vision

Mostly cones
1/3 of all nerve fibers

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16
Q

Define Optic disc

This structure lacks rods and cones so is AKA the ?

A

Nerve fiber convergence to leave eye; visible portion of optic nerve in eye

Physiologic blind spot, 15* temporally

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17
Q

What are the four rectus muscles of the eye?

What are the two oblique muscles of the eye?

Eye muscles work in ? meaning that ? process have to work for movement

A

Superior Lateral Inferior Medial

Inferior Superior

Tandem, yoked
Ipsilateral opposing relax for movement to occur

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18
Q

Define LR6SO4REST3, movement and CN innervation

A 
SR: elevate, 3
LR: abduct, 6
IR: depress, 3
MR: adduct, 3
IO: extort/elevate, 3
SO: intorsion/depress, 4
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19
Q

What are the 3 layers of tears and where are they produced?

What is the sequence of drainage out of the eye?

A

Outer- oil, meibomian gland
Mid- lacrimal, accessory
Inner- mucin, goblet cells

Punctum
Canaliculus
Lacrimal sac
Nasolacrimal duct

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20
Q

Optic pathway is ? pathway while the oculomotor and Parasymp are ? pathways

Define the Double Decussation

A

Afferent (eye to brain)
Efferent (brain to iris)

Direct and consensual response of crossing at:
Chiasm
Pretectal/EW nuclei

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21
Q

When needs to be done at minimum during an eye exam?

A 
Acuity- glasses preferred
Direct ophthalmoscopy- undilated
Pupils
Intraocular pressure
EOMs
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22
Q

How is distance visual acuity assessed?

Visual distance acuity charts are calibrated for ? distance

What eye is done first?

A

Ratio: standard/patient performance
TD/LS (test distant/letter size)

20ft

R (OD)

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23
Q

What is the conversion if PT can read 20/20 at ten feet?

What are the f/u tests if PT can’t read chart?

A

20/40

Count fingers
Hand motion
Light perception

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24
Q

Typically near vision acuity is only done ?

This form of acuity is best for ? PT populations?

A

Near vision complaint
>40y/o

Bed ridden

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25
How far from the face is the near visual acuity test conducted? When dealing w/ PT ocular compliant, visual acuity becomes a ? and is abbreviated as ?
14-16" VS OD OS OU cc: w/ correction sc: w/out correction
26
? is done on ALL PTs w/ occular complaints and prior to ? procedure? Define Visual Impairment Define Visual Disability
Visual acuity Prior to putting anything in eye (exception: chemical splash) Condition of the eye Condition of PT
27
What is a near normal, mod/low, sev/low and legally blind score? Pinhole acuity test is done when vision is worse than ? and is AKA ?
20/25-20/70: near norm 20/80-20/160: mod low 20/200cc-20/400: sev low/legally blind 20/40 Visual potential
28
What is the difference between AF and Army flight physical cardinal movements? What is the purpose of cardinal movements?
AF: 6 Army: 8, add up/down Symmetrically tests each muscle for: Paralysis Entrapment Weakness
29
Why are eyes w/ shallow anterior chamber depths not dilated? What meds are used for dilation?
Triggers angle closure glaucoma crisis Undergoing pupil observation Mydriatics: Adrenergic- dilation Cholinergic- paralyzes sphincter
30
What is the adrenergic stimulating medication? What are the five cholinergic blocking agents? If PT gets one of these drugs, how is their vision changed and why
Pheylephrine ``` Cycopentaolate x 24hrs Homatropine x 72hrs Atropine x 2wks Tropicamide x 6hrs Scopolamine x 1wk ``` No accommodation= blurry near vision due to ciliary body involved
31
What items are looked for when doing ophthalmoscopy exam? Why is intraocular pressure measured and what is a normal range?
Red reflex Optic disc (physiologic cup) Retinal circulation/back ground Macula Glaucoma screening by measuring aqueous outflow 10-21mmHg
32
What are the two methods of measuring intraocular pressure? What is the gold standard for testing IOP? What is the name of the eye exam used to evaluate the macula?
Tono-pen- ask about latex allergy and anesthetize first Non-contact tonometry- air puff test Goldmann tonometry Amsler grid test
33
What are the components of a basic eye exam?
``` Confrontational fields Ocular motility Ophthalmoscopy Pupillary reaction Pressure, intraocular Acuity Anterior chamber depth Ancillary- Amsler Color Eversion ```
34
# Define Emmetropia Define Hyperpropia
Normal state, objects at infinity seen clearly w/ unaccommodated eye Far sighted, axial length is short, image falls behind retina
35
# Define Myopia Define Astigmatism Define Presbyopia
Near sighted, axial length is long, image falls in front of retina Elliptical shape, different refracting power between cornea/lens No accommodation due to lens hardening Typical manifestation= no ability to focus on near objects
36
How does the curvature of glasses change for the different type of vision? What are the other parts possibly seen in glasses prescriptions?
+ sphere: hyperopia - sphere: myopia Cylinder: astigmatism correction Axis: astigmatism orientation for the eye Prism- amount and direction Bifocal- if needed for reading, always a +
37
How are lens prescriptions written? What are the three types of eye deviations?
(Sphere) - (Cylinder) x (Axis) Orthophoria- no deviation during cover/Hirshberg Heterophoria- normal deviation, discovered with alternating cover test Heterotropia- deviated when using both eyes, seen on alternating cover test
38
Heterotropia is AKA ? When is this condition is congenital, what happens? What eye tends to have the worse vision?
Tropia One eye suppressed to eliminate double vision Most deviated has worse vision (amblyopia)
39
# Define Strabismus Define Phoria Define Tropia
Misaligned eyes Deviation only seen when one eye is covered Deviation seen when both eyes are open/uncovered
40
# Define Concomitant Strabismus This type of deviation leads to ?
Non-paralytic strabismus Misalignment equal in all directions of gaze w/ early onset Bad vision acuity
41
# Define Incomitant Strabismus Define third, fourth and sixth vasculopathic tropias
Misalignment varies w/ direction of gaze due to nerve dysfunction or mechanical restriction 3: aneurysm 4: congenital trauma 6: cranial pressure
42
# Define Nystagmus What do most of the PTs with this condition suffer from?
Involuntary movement of eyes Partial sightedness Legally blind
43
What are the two classifications of nystagmus? What are the two classifications based on eye movement patterns?
Physiological- evoked, eyes far to one side, tracking object Pathologic- abnormal, congenital (<6mon), acquired (>6mon) Pendular- eye movements equally paced in each direction Jerk- slow drift in one direction, rapid movement back
44
What are the four parts to a Hx when working up a nystagmus? How are alternating nystagmus Tx How are severe/disabling cases Tx
Infancy occular Hx Drug/alcohol use Vertigo TBI Baclofen- not for Peds Retrobulbar botulinum injection
45
# Define Amblyopia These are AKA ?
Defected vision w/out detectable anatomic damage Lazy eye
46
What are the four etiologies of amblyopia
Refractive: large uncorrected error (anisometropia) Strabismus: deviated eye becomes amblyopic Occlusion: ptosis/patching or media opacities Organic: toxin, nutrition
47
How are amblyopias tested for at different ages? What type of results are of low concern
<2: visual function 2-5: acuity picture cards 20/40 and equal eyes
48
How is strabismus testing done in PTs w/ amblyopia What DDx may be considered? What normal PE finding is poorly seen in these PTs?
Corneal light reflex test Cover test Epicanthus Red reflex
49
What type of refractive error is more common in amblyopia How are strabismus' Tx in amblyopia PTs
Hyperopia Patch better eye 2-6hrs/day >11y/o- usually unsuccessful, polycarbonate lens
50
Surgical correction of strabismus' are delayed until ? Define Ec/Entropion What are the Sxs of Ect/Entropion can include tearing d/t?
Vision is stabilized Ec: lower lid turns out En: lower lid turns in Ec: punctal malposition En: lashes abrading globe
51
What are the 4 etiologies of ectropion?
Paralytic: CN7 palsy Involutional: lower lid laxity Cicatricial: scarring Mechanical: mass on lid/cheek
52
What are the two etiologies of entropion? How are both Ect/Entroption Tx?
Involutional: lid laxity w/ age Cicatricial: conjunctival scarring Surgery
53
# Define Lagophthalmos What Sxs does this present w? What will be seen on PE?
Inability to close eyes Foreign sensation Irritation Tearing- failed lacrimal pump Inability to close eyes Exposed keratopathy
54
What are the 5 etiologies of lagophthalmos?
``` Lower lid laxity w/ age CN7 palsy Proptosis Over corrected ptosis/blepharoplasty from sugery Lid trauma causing scars ```
55
How is lagophthalmos Tx
Mild: tears/gels/ointment Tape eye close at bed Mod/Sev: tarsorrhaphy, suture lids together, gold weight inserted under lid for permanent Tx
56
# Define Ptosis What are the presenting Sxs?
Drooping of upper lid ``` Obstructed upper vision Difficulty reading Secondary amblopyia (peds) ```
57
What are the etiologies of Ptosis How are congenital/acquired cases Tx
``` Congenital: abnormal levator Acquired: thin/detached levator aponeurosis Horners CN3 Palsy w/ ophthalmoplegia M Gravis ``` Surgery: Tighten levator aponeurosis Resect levator muscle
58
# Define Blepharitis How does this present
Scaling of lid margin proximal to lashes Photophobia Itching Burning Epiphoria- excess tears
59
What are the MC causes of blepharitis How is this Tx
Demodex Meibomian dysfunction (chalazia) Seborrhea Staph infection (hordeola) Margin shampoo/scrub Warm compress w/ massage Staph: Erythromycin ung Gland: Doxy 100mg PO QD Erythromycin 200mg PO BID
60
# Define Hordeolum How are these caused?
AKA stye Acute painful nodule Staph infection Sebaceous gland
61
How are hordeolums Tx When are these referred to surgery? What are the two adverse outcomes?
Warm compress/massage Erythmycin ointment PO Doxy if + blepharitis Compress/ABX fail after 4wks Need for rapid relief En/Ectropion
62
# Define Chalazion What do PTs complain of at presentation
Lipogranulomatous inflammation from meibomian gland obstruction Mildly tender
63
How are Chalazions Tx When are these PTs referred to surgery?
Warm compress Triamcinolone injection- c/i in dark complexion PTs No resolution after 1mon Incision and curettage of meibomian gland
64
# Define Dacryocystitis What are the presenting Sxs What will be seen on PE?
Inflammation of lacrimal sac at nasal end of gland Tearing Pain D/c Erythema Preseptal cellulitis
65
What is the etiological cause of Dacryocystitis How is this Tx
Bacterial infection Nasolacrimal duct obstruction Amox/Clavu 500mg PO q8hrs Warm compress/massage InD Febrile= admit/IV ABX
66
When are dacryocystitis referred for surgical correction? What is the name of the procedure?
Chronic Once acute episode has resolved Caryocystorhinostomy
67
# Define Dacryoadenitis What presenting Sxs will PTs have What will be seen?
Inflammation of lacrimal gland Swelling Pain Tearing Swollen tender and erythematous gland
68
What three autoimmune issues can lead to dacryoadenitis What two viral agents can rarely cause this?
Sarcoidosis Sjogrens Vasculitis Mono Mumps
69
What is done during work up for dacryoadenitis If unclear etiology, how is this Tx? If infectious etiology, how is it Tx?
CT scan of orbit Biopsy lacrimal gland Systemic ABX, f/u q24hrs Amox/Clavu: 500mg q8hrs Cephalexin: 500mg q6hrs
70
What are the more common skin Cas that can affect the lid? What is the surgical procedure for removing one of these? How are PTs Tx if unable/unwilling to have surgery?
Basal cell Squamous Mohs removal (basal) Radiation
71
# Define the conjunctiva What are the two Define Fornix
Thin mucous membrane Palpebral- inner eye lid Bulbar- over sclera Location where the two meet
72
What is the MC cause of viral conjunctivitis How does this present?
Adenovirus Preauricular adenopathy Pink hue that usually spreads to unaffected eye Watery d/c
73
How is viral conjunctivititis Tx What PT education goes w/ this Dx
Cold compress/tears Topical steroids if infiltrate/membrane present ABX only if secondary infection Highly contagious mid-7 days
74
What are the MC causes of bacterial conjunctiviits What 3 DDxs need to always be considered?
Staph A Strep pneumo H Influenzae N gonorrhea N meningitidis C trachomatis
75
If PT presents w/ the 3 DDx for bacterial conjunctivitis, what is the next step and why? What are the Sxs of bacterial conjunctivitis?
Ophthalmology ASAP Gonococcal ulcer perfs quickly Lid adhesions Beefy red/irritation More likely unilateral
76
How are bacterial conjunctivitis cases worked up? How is this Tx?
Gram stain/culture if Neisseria Dx suspected Trimeth/Polymyxin QID x 7d Besi/Moxifloxacin QID x 7d Ceftriaxone 1g IM Azith 1g PO x 1 dose Doxy 100mg PO x 7d PCN c/i: Cipro 500mg PO x 5d
77
How is bacterial conjunctivitis Tx if Neirsseria has invaded cornea? What can cause allergic conjunctivitis? What type of hypersensitivity are these reactions?
Admit for IV ABX: Ceftriaxone 1g IV q12hrs Animal Molds Pollen Type 1
78
How does allergic conjunctivitis present? How are these cases Tx What PO antihistamines can be tried?
Intense itch w/ watery d/c Bilateral erythema w/ stringy mucoid d/c Mild: tears Mod: topical mast stabilizers: Olopatadine, Ketotifen Sev: topical steroid: Loteprednol Cetirizine Fexofenadine Diphenhydramine
79
How does subconjunctival hemorrhage present? What medications can cause this?
ASx blood in one sector under conjunctiva ASA Warfarin
80
Subconjunctival hemorrhage presenting w/ ? Sxs needs an orbital CT? How are these cases Tx
Proptosis EOM restrictions Elevated IOP Tears D/c elective ASA
81
# Define Pinguecula and Pterygium How are they similar? How are they different?
White/yellow bump on conjunctiva at 3 or 9 o'clock position Highly vascularized PTs at equitorial regions w/ chronic sun exposure Ptery- invades cornea Ping- no cornea invasion
82
How are Pingueculas/Pterygiums Tx Define Phylctenule and what causes it
Tears/topical steroid (sev) Surgery- ptery interferes w/ sight/visual axis Nodular growth at limbus from bacterial protein (Staph) hypersensitivity
83
If unable to refer/evac PT w/ phylctenule, how are they Tx? Define Conjunctival Nevus These cases can but rarely develop into ?
Steroid/ABX combo: Tobra/Dexameth Tobra/Lotaprednol Benign/ASx pigmented lesion over sclera Malignant melanoma; vascular network seen through conjunctiva
84
How are conjunctival nevus Dx What is the major concern in PTs presenting w/ conjunctival lacerations?
Biopsy necessary Resected if suspicious Ruptured globe Retained foreign bodies
85
How are conjunctival lacerations Tx Define Thyroid Eye Dz
<1cm: Erythromycin oint TID >1cm: surgical closure Graves Ophthalmopathy but can be seen in hyper/po/euthyroid PTs too
86
What is the MC cause of bilateral and unilateral ptosis in adults? What work up is done and how is the Dx confirmed
Thyroid Eye Dz Complete thyroid work up Normal= careful monitoring CT to confirm
87
What phase of Thyroid Eye Dz does the upper eye lid retraction begin? How are mild, mod and severe cases Tx
Early ``` Mild: tears, elevate head, tape lids at night Mod/Sev: PO Prednisone Decompression/radiation Lid repair Strabismus surgery ```
88
What are the buzz word differentiators for the different types of conjunctivitis? Any damage to cornea results in ?
Viral: preauricular adenopathy Bacterial: mucopurulent d/c Allergic: intense itches Visual impairment
89
# Define Keratitis What are the 5 layers of the cornea from out to in?
Inflammation of cornea ``` Epithelium Bowman membrane Stroma Descemet's membrane Endothelium ```
90
How is erosion damage to the corneal epithelium seen on PE? Corneal ulcer implies damage to ? layer
Sodium Fluorescein stain Stromal damage from infiltrate
91
What is the difference in presentation between bacterial/fungal and sterile infiltrates in corneal ulcers?
B/F: Extremely painful, aggressive Blindness <48hrs St: Minimal pain, most on peripheral cornea Secondary to contact wear
92
What are the S/Sxs of a HSV Keratitis ulcer? What will be seen if it's an advanced dz?
Epithelial dendrites Photobphobia Almost all- unilateral Stromal scarring vascularization
93
How is HSV Keratitis Tx What is NOT given to these PTs?
Referral Antivirals Topical ulcers can cause ocular perforation/tissue loss
94
# Define Bacterial Keratitis What are the MC microbes causing bacterial keratitis?
Bacterial colonization on cornea, interrupts intact corneal epithelium Staph Strep Pseudo Morax Serratia
95
What PT population is bacterial keratitis MC in ? How is this Tx
Contact wearers w/ over night wear Fluoroquinolone q1-2hrs Tobra/Cipro if contact wearer Daily monitoring Vision threatened: fortified AB q30min
96
What type of Hx highly suspects fungal keratitis? What other Hx may suggest this?
Outdoor eye trauma w/ vegetative matter Topical CCS use Contacts Recent surgery
97
What is the MC presentation of fungal keratitis? How are these cases Tx What meds can be used for Tx
Feathery white opacity Initial, same as bacterial Refer to Ophth for culture Surgical debrisment Topical Natamycin/Amph B Fluconazole Voriconazole
98
What med is c/i for Tx of fungal keratitis? What drugs can cause corneal pigmentation? What is the benefit of getting this issue?
Topical steroids Hydroxy/Chloroquine- deposits Amiodarone- whorl shaped Phenothiazines Indomethacin Rarely causes vision loss Most resolve w/ drug d/c
99
What is the MC cause of recurrent corneal erosion? How does this case present?
Dog claw Mid-morning/late night onset of sudden/severe pain "Sharp pain w/ eye open" "Eyelid stuck to front of eye"
100
How are recurrent corneal erosion Tx When are these PTs referred to surgery?
Muro-128 ointment to dehydrate cornea at night Tears during day PO analgesic Dilate to ease accommodation spasm Severe, 90% success
101
# Define Keratoconus If this becomes severe, it can lead to ?
Dz of unknown etiology causing thinning of central cornea Leads to increased myopia, irregular astigmatism Blindness Corenal transplant
102
# Define Munson Sign What other unique findings may be seen on PE?
Keratoconus- bulging lower lids from thinning central cornea bulge on inferior cornea Fleischer RIng at base of cone Vogt's Striae
103
# Define Arcus Senilis When does this condition go from normal aging process to abnormal finding? What finding on PE confirms this Dx?
Gray/white deposits on peripheral cornea Under 40, hyperlipoproteinemia Clear area between deposit and limbus w/out vision changes
104
What are the two functions of the sclera What is it made of? Where is the thickest point?
Protection EOM attachment points Collagen Elastic fibers Posterior aspect
105
Episclera is connected to ? What is the function of this attachment structure
Tenon's capsule Dense CT encasing globe Sheath covering tendons at EOM insertions
106
Episcleritis is more prevalent in ? but is MC ? What d/os are associated w/ this eye issue?
Young adults Idiopathic ``` HZoster RA/Lupus Rosacea Thyroid dz Syphilis ```
107
How does episcleritis present What is done during work up?
Acute sectorial presentation w/out d/c Slit-lamp w/ anesthesia- Mobile vessel w/ CTA Phenylephrine lets vessel blanch
108
How is episcleritis Tx
Mild: Cold compress/tears Mod/Sev: Fluorometholone Ibuprofen Loteprednol
109
What CT Dzs can cause scleritis What infections can cause it? What is different about scleritis and what is the prominent feature?
Wegeners RA Ankylosing P nodosa Lupus Herpes zoster Syphilis Older PTs Severe/boring eye pain radiating to jaw/brow
110
How is this condition classified?
Diffuse- wide inflammation Nodular- immovable inflamed nodule Necrotizing w/ inflammation- extreme pain from systemic dz and blue appearance Necrotizing w/out inflammation- no Sxs but long standing dz (RA) Posterior- unrelated to systemic Dz
111
Posterior scleritis can cause ? injury to occur How is scleritis different on PE? What two examinations need to be done?
Exudative retinal detachment Phenylephrine doesn't allow blanching Slit lamp w/ green light- r/o avascular areas Fundus exam- r/o posterior scleritis
112
How is diffuse/nodular scleritis PTs Tx What meds are used if there is no improvement?
All referred to Ophth and: NSAIDs Ranitidine Prednisone Clophosphamide
113
How is necrotizing sclertitis Tx How is posterior scleritis Tx
Refer NSAIDs Rantidine and, Clophosphamide Perf= scleral patch graft Controversial use of: Cyclophosphamide Rituximab Glucocorticoids
114
What are the three pats of the uveal tract? When this tract becomes inflamed, what is the Dx w/ ? area of involvement?
Iris- only visible portion Ciliary body Choroid ``` Uveitis Ant: iris, ciliary body Inter: between ciliary body and early retina Post: retina Pan- all areas ```
115
Anterior uveitis is AKA ? What are the associated RFs for this Dz?
Iritis Iridocyclitis HLA-B27 (AS, Reiters) JA TB/Syphilis Lymphoma
116
What are the S/Sxs of anterior uveitis? What might be seen on PE?
Ciliary flush/injection Keratic precipitates: fine/white- non-granulomatous mutton fat- granulomatous Floaters/Flares Hypopyon- cells at bottom of anterior chamber Irregular pupil Koeppe/Busacca nodules
117
How is anterior uveitis Tx What is the prognosis difference for PTs w/ this Dx?
Clycloplegics: Scopolamine- mild/mod Atropine- severe Topical steroid: Prednisolone First: non-granulous excellent Repeat granulomatous- poor
118
Posterior uveitis is a combo Dx of what 3 things What is the MC cause?
Vitreitis Choroiditis Retinitis Toxoplasmosis
119
What is the MC severe infection affecting the eye? What PT population does this occur in? What happens if this is left untreated?
CMV retinitis CD4<100 Blind <6mon
120
What is the MC finding of CMV retinitis What else may be seen on PE?
Cotton wool spots Scotomata Flashes w/ retinal detachment Stellate shaped KPs
121
How is CMV retinitis Tx How is posterior uveitis Tx
HAART PO Valganciclovir Refer Topical cycloplegic/steroid w/ anterior involvement
122
How is non-necrotizing/posterior uveitis due to RA Tx How is the necrotizing form Tx?
Tears PO NSAIDs/steroids No topical steroids Scleral patch graft if high risk for perf
123
What part of the body has the highest concentration of protein concentration? What strctures are lacking here? What are the 3 layers?
Lens Blood vessels Nerves Capsule Cortex Nucleus
124
What are the functions of the capsule? What are the functions of the cortex?
Semipermeable membrane that envelopes/molds lens during accommodation Produce lens cells, fibers for life Older cells are deeper, lose organelles to become transparent
125
What is the MC RF for developing cataracts? What does the cataract have another MC with
Age Cataract surgery- MC done in US
126
What is the MC form of age related cataracts? What type of vision issue does the PT present w/? What is a benefit w/ a saying?
Nuclear sclerosis- yellow/brown discoloration Blurry distance vision Second sight of the aged, more myopic
127
# Define Posterior Subcapsular What do PTs present complaining of? What is the MC cause?
Opacities near posterior aspect of lens Glare and difficulty reading >50y/o
128
# Define Cortical cataract How does this present? Why is this usually not seen in routine clinic?
Radial/spoke like opacities ASx until central progressino, causes glare as MC Sx Reqs pupil dilation
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What is the MC complaining Sx of cataracts? What other Sxs/issues may be seen?
Progressive vision loss w/ glare from oncoming headlights Monocular diplopia Fixed spots in visual field Dec color perception- blue hair dye
130
How are catarcts Tx Cataract surgery is done for ? reasons?
Early: spectacle prescription Small central: pupil dilation Late: surgical removal Temporary benefit w/ Scopolamine Glaucoma Improve visual function ARMD Diabetic retinopathy
131
Congenital cataracts are MC ? This condition can potentially have ? sole presenting issue?
Idiopathic Galactosemia
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What are the different types of congenital cataracts? How can these present?
Posterior polar Coronary Lenticonus Sutural Lamellar Anterior polar Blue dot Dec vision Infant squinting/eyes closed Absent/abnormal red reflex
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When working up congenital cataracts, whose Hx is important? What PT population is this a medical emergency, why? These PTs need to be referred to prevent ?
Maternal Infant w/ cataracts- brain learns to see w/ macula during first 3-4mon Deprivational amblyopia
134
# Define subluxation lens position anomaly Define dislocation lens position displacement?
Partial zonular disruption, lens de-centered but partially visible in pupillary aperture Complete disruption of zonular fibers Lens is displaced out of natural position in posterior chamber
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What are the two MC causes of lens position anomalys? What types occur and what is retained by the PT
Trauma- subluxation Marfans Syndrome- superotemporal subluxation w/ retained accommodation
136
What type of subluxation occurs w/ homocystinuria? What is lost in this type of lens anomaly?
Inferonasal subluxation/dislocation Accommodation lost
137
# Define Phacodonesis Define Iridodonesis Where are these issues seen?
Quivering lens Quivering of iris Lens position anomaly
138
How is lens dislocation into anterior chamber Tx How are lens subluxations Tx?
Replaced w/ head manipulation or surgery ASx- observe Significant Sxs- surgery Surgery, only if PT has Sxs
139
What is the MC cause of floaters? What can cause an acute onset?
Age ``` DM/Sickle induced bleeding Retinal tear Int/Post uveitis Posterior vitreous detachment Foreign body ```
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If PT complains of flashes, what does this suggest? What two things must be r/o?
Traction of vitreous on paripheral retina Retinal detachment Posterior vitreous detachment
141
PTs w/ flashes and floaters mean ? If PT presents w/ flashes and migraine, what can be seen?
Blood/pigment in vitreous Scintillations Zig-zag lights
142
# Define Weiss ring How do PTs w/ vitreous opacities present?
Vitreous opacity seen by PT after vitreous detachment Floaters Blurry to severe vision loss
143
Where is the fovea Where does macula get blood supply from?
4mm temporal 0.8mm inferior to optic nerve Yellow dot/vasculatur is medial to black dot (temporal) Optic nerve is nasal portion of retina Choroid
144
How do arteries/veins differ in the retina on exam? How do they cross each other in the eye?
Arteries- thinner, orange/red Vein- larger, crimson Arteries/veins cross each other No V/V or A/A crossing
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What is the only place in the body vessels are visible w/out doing surgery What structures supply blood to the retina
Retina Central artery- inner retina Choroid- outer retina and photo receptors d/t high O2 demand
146
What physical feature can tell if PTs fundus is light or dark? What are the two parts of the inner retina? Where does this structure extend through?
Skin tone Nerve fiber layer (to midbrain w/ pupillary response) Ganglion cell layer Optic chiasm to geniculate nucleus
147
Retinal vascular ischemia issues manifest in ? layer What will be seen on PE?
Nerve fiber layer Opacification of inner retina - cotton wool spots in DM
148
Retinal artery occlusion involving the branch of the retinal artery will present w/ ? What part of the eye may be spared and why?
Horizontal hemifield vision loss Macula- cilioretinal arteries from choroidal supply
149
What are the RFs for retinal artery occlusion? How does central retinal artery occlusion present? What other RFs/Hx may be present
Lupus OCPs GCA Unilateral painless acute vision loss Light perception or worse Afferent pupil defect Hx of amoaurosis fugax
150
What will be seen upon fundoscopic exam during central retinal artery occlusions? How does branch retinal artery occlusions present?
Opacification/white retina Cherry red spot in center Box-car/segmented arterioles Unilateral painless acute altitudinal/sectoral field loss
151
What is different about the prognosis in BRAOs? What is the first labs ordered for suspected CRAO/BRAOs?**
Permanent visual field defects Rare neovascularization Platelets ESR CRP** PT >55y/o, r/o GCA
152
How are CRAO/BRAOs Tx? How are retinal vein occlusions going to present?
Ocular massage Anterior paracentesis Acetazolamide Ophthalmic Timolol Horizontal hemifield loss w/ respect to horizontal midline
153
What causes retinal vein occlusions? What is the biggest risk factor?
Thickened arterioles compressing veins causing stagnant outward flow >65y/o
154
What will be seen on funcdoscopic exam of central retinal vein occlusions? What are the two different types of occlusions?
Blood and Thunder fundus Dilated veins Swollen disc Ischemic- cotton wool spots w/ extensive hemorrhage Non-ischemic- mild fundus changes
155
What is the prognosis of BRAO? What can cause prognosis to be complicated?
Good, half develop collateral vessels Chronic macula edema Noevascularization
156
How are retinal vein occlusions Tx How are these PTs Tx if there is neovascularization or macular edema present?**
Ophtho eval <72hrs D/c OCPs Dec IOP Intravitreal anti-VEGF** injection PRP ASA one x/day
157
What is the leading cause of blindness in PTs < and >64y/o? After PTs are Dx w/ this an ocular baseline must be established w/in ?
<64- DM >64- macular degeneration 6mon
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What type of DM rarely has retinopathy? This benefit wears off though and is prevalent after how long?
Type 1 30yrs
159
What are the RFs for diabetic neuropathy? What hormonal influences can accelerate the retinopathy?
``` Duration Control Pregnancy HTN Nephropathy ``` Pregnancy Puberty
160
What are the two types of diabetic neuropathy?** What will be seen in each type?
Non-proliferatve: Mild/Mod/Sev Cotton wool Hemorrhage IRMA Miroaneurysm Exudates Proliferative**: Late, new vessels grow at disc
161
What may be seen during the 4 phases of non-proliferative diabetic neuropathy?
Very mild: microaneurysms Mild: Microaneurysms Exudate Cotton wool spots Mod: Retinal hemorrhage in 1-3 quadrants or mild IMRA Sev: 4-2-1 rule 4 quad- retinal hemorrhage 2 or more: venous beading 1 or more: moderate IMRA
162
What is the MC factor indicating a PT has progressed from non-proliferative to proliferative diabetic retinopathy?** What constant sequelae will be seen in these PTs?
Neovascularization Fragile vessels= recurrent hemorrhages
163
What are the Sxs of proliferative diabetic retinopathy What signs may be seen
Slow dec of vision Floaters, 2/2 hemorrhage Scotomas Lacy vessel- Nerve Retina Iris Boat shaped pre-retinal hemorrhages, anterior to retinal vessels Cotton wool spots Absent red reflex
164
How is diabetic retinopathy Tx
NPDR- tight glucose control + Neovascular changes- Anti-VEGF PRP
165
How does macular edema present? What causes retinitis pigmentosa?
Gray/opacified retina Micro-aneurysms Dot/blot hemorrhage Exudates Loss of viable photoreceptors, initially rods Retinal pigment changes
166
How does Retinitis Pigmentosa present? What signs may be seen on PE? How is it Tx
Lost color/peripheral vision Night blindness Photopsia Scotoma Bone spicules Golden-ring sign Vit ADEK Low vision aids
167
What are the 3 types of retinal detachments
Rhegmatogenous- break in myopic eyes (higher Rx= higher risk) Exudative- leakage w/out a break d/t something below retinal layer Tractional- contraction of fibers pulling on retina, diabetic/retinopathy or prematurity
168
What are the presenting S/Sxs of a rhegmatogenous retinal detachment? How are retinal detachments worked up? What can be done in clinic to aid w/ Dx?
Flashes and floaters Referral for complete dilated ocular exam Red reflex from distance, detachment eye will be lighter
169
How are rhegmatogenous retinal detachments Tx? How are tractional detachments Tx?
Pneumatic retinopexy- intravitreal gas bubble w/ laster Scleral buckle- silicone belt around globe Pars plana vitrectomy
170
What are the two different types of macular degeneration What is the MC abnormality
Non-exudative, dry Exudative, wet Drusen- yellow deposits on retina, limits nutrition to photoreceptors
171
What are the RFs for macular degeneration? What are the S/Sxs of Dry AMD? What will be seen on exam
Older female w/ light pigmentation who smokes and FamHx Gradual loss of central vision Macular drusen Pigment clumps on outer retina
172
What are the S/Sxs of Wet AMD What will be seen on fundoscopic exam?
Distortion of straight lines- metamorphopsia Rapid loss of central vision Drusen Neovascularization Hemorrhages
173
What are the RFs for progressing from Dry to Wet AMD?
``` Age Hyperopia Blue eyes FamHx Larger drusens Focal clumping HTN Smoking ```
174
How is AMD Tx
Dry: Vit C E Beta-carotene Zinc No Beta-carotene for smokers Wet: Anti-VEGF Laser photocoagulation
175
What is the hallmark of hypertensive retinopathy What else may be seen
Diffuse arteriolar narrowing Copper wire vessel- arteriol narrowing Silver wire- sclerosis A:V ratios 1:3 or 1:4
176
What are the Sxs of hypertensive retinopathy What are the signs?
Scotomas Double vision Cotton wool spots AV nicking
177
How to tell hypertensive retinopathy from diabetic retinopathy What are the S/Sxs of chloroquine toxicity
HTN- dry, more white than hemorrhage Abnormal color vision Difficulty adjusting to dark Bulls-eye maculopathy
178
How often do PTs on chloroquine need eye exams When examining PT eyes, presence of hemorrhage indicates ? type of ARMD
Baseline w/in first year Annually after 5yrs of use Wet- needs anti-VGF
179
PT complains of loss of vision w/ description of 'curtain pulled down' is indicative of ? If curtain sensation was accompanied by flashes and floaters would indicate?
Retinal detachment Rhegmatogenous
180
Cherry red spot on macular means ? What part of the eye has the highest resistance for the flow of aqueous humor? This point of high resistance is AKA ?
CRAO Trabecular meshwork at junction of cornea/iris Anterior chamber angle
181
Where does aqueous humor exit the eye? Define glaucoma
Schlemm's canal Progressive optic nerve damage and visual field loss
182
What are the two categories of glaucoma What measurement is used to assess the progression of glaucoma
Open angle- MC, normal outflow pathway Angle closure- blockage of outflow Cup to disc ratio Smaller= less visible cup Larger= more concern
183
# Define Ocular HTN How is this Tx
Normal nerve Normal anterior chamber No visual field loss IOP >21 Monitor annually
184
# Define Primary Open Angle Glaucoma What two mechanisms can lead to this?
Loss of retinal fiver layer and reduction of vision Vascular- optic nerve ischemia Mechanical- cribiform plate compression
185
What is the only modifiable RF against primary open angle glaucoma? This condition may AKA ?
IOP >28 Thief in the night-
186
What is the sequence of progressive vision loss seen in Primary Open Angle Glaucoma What are the RFs for this condition
Parts of pages are missing Tunnel vision- late Central fixation- preserved until late Temporal island- remaining visual field Age >50 AfAm/hispanic FamHx DM
187
What is not a RF for primary open angle glaucoma What part of the day is IOP the highest
Systemic HTN Morning
188
Normal tension glaucoma is AKA ? and is a variant of ? What will be seen?
Low tension glaucoma POAG IOP 21 or less Open anterior chamber Visual field/optic nerve damage
189
What is a unique RF for normal tension glaucoma What are the two mechanisms causing acute angle closure glaucoma
Obstructive sleep apnea Relative pupil block- iris pushed forward Non-pupil block- iris pulled/positioned anteriorly (inflammatory conditions)
190
PT presents w/ intense ocular pain, photobia, N/V, what is the Dx What precipitating event is seen?
Acute Angle Closure Glaucoma Leaving movie theater
191
How are AACG attacks stopped What med is used if their IOP is <50? What is the Tx of choice?
1 drop q5min of : Timolol Apraclonidine Prednisolone/Dexameth Acetazolamide 500mg IV Laser iridotomy
192
What causes Chronic ACGlaucoma? How is this Tx
Anterior angle closed by peripheral anterior synechiae (front of iris binds to corneal endothelium) Trabeculectomy/tube shunt`
193
PT presents w/ Port-Wine stain, what eye issue may be present? What may be seen on the cornea during PE?
Sturge Weber syndrome presents w/ congenital glaucoma Linear tears- Descenemet membrane Haab striae- horizontal
194
How is congenital glaucoma Tx
PO Acetazolamide Topical Levobunolol/Timolol Surgery- Goniotomy Trabeculotomy/ectomy/shunt
195
Mother brings baby to clinic w/ complaint of squinting, blinking hard and IOP is 32. Dx? What causes secondary glaucoma?
Congenital glaucoma Males playing sports, has blunt trauma and experiences glaucoma at 10yrs
196
What causes neovascular secondary glaucoma? What will be seen on exam? How is it Tx
Fibrovascular membrane grows into meshwork, slows drainage Vessels growing into iris Timolol, PRP
197
Where/why wold steroid response glaucoma be seen? Dx of glaucoma requires ? two things, otherwise its ? Dx
Refractive surgery Reqs: optic nerve damage, progressive vision field loss Ocular HTN
198
# Define Hemianopia Define Homonymous
Loss of half of visual field Visual field loss on same side of both eyes
199
# Define Scotoma Define Anisocoria
Red/absent vision w/in intact visual field Unequal size of pupils >1mm
200
? and ? make up the photoreceptors in the retina Where does initial visual processing and interpretation take place?
Nerve fiber layer Optic nerve Process: Retina Interpret: visual cortex
201
Where does the optic tract stop This location is AKA ?
Lateral geniculate body Neural way station, axons leave as optic radiations
202
What type of vision occurs w/ lesion in chiasm? Afferent pathway is CN ? Efferent pathway is CN ?
Bitemporal heminopsia A2 E3
203
Double decussation is responsible for ? response Marcus Gunn pupil is a ? defect and what occurs
Direct/consensual Afferent Light in good eye, normal constriction response Shine light in bad eye, both pupils dilate
204
What causes Adie's Tonic pupil What is seen on PE Else would be seen on neuro PE
Denervatin of PNS supply to sphincter and ciliary muscle Irregularly dilated, poor reaction to light Slow accommodation Dec/absent knee/ankle DTRs
205
How is an Adie's Tonic pupil Dx confirmed
Pilocarpine Adies constriction Normal pupils- no constriction

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