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IPAP > Ophthalmology > Flashcards

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
Q

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 ?

A

14-16”

VS
OD OS OU
cc: w/ correction
sc: w/out correction

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26
Q

? is done on ALL PTs w/ occular complaints and prior to ? procedure?

Define Visual Impairment
Define Visual Disability

A

Visual acuity
Prior to putting anything in eye (exception: chemical splash)

Condition of the eye
Condition of PT

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27
Q

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 ?

A

20/25-20/70: near norm
20/80-20/160: mod low
20/200cc-20/400: sev low/legally blind

20/40
Visual potential

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28
Q

What is the difference between AF and Army flight physical cardinal movements?

What is the purpose of cardinal movements?

A

AF: 6
Army: 8, add up/down

Symmetrically tests each muscle for: Paralysis Entrapment Weakness

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29
Q

Why are eyes w/ shallow anterior chamber depths not dilated?

What meds are used for dilation?

A

Triggers angle closure glaucoma crisis
Undergoing pupil observation

Mydriatics:
Adrenergic- dilation
Cholinergic- paralyzes sphincter

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30
Q

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

A

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

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31
Q

What items are looked for when doing ophthalmoscopy exam?

Why is intraocular pressure measured and what is a normal range?

A

Red reflex
Optic disc (physiologic cup)
Retinal circulation/back ground
Macula

Glaucoma screening by measuring aqueous outflow
10-21mmHg

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32
Q

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?

A

Tono-pen- ask about latex allergy and anesthetize first
Non-contact tonometry- air puff test

Goldmann tonometry

Amsler grid test

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33
Q

What are the components of a basic eye exam?

A 
Confrontational fields
Ocular motility
Ophthalmoscopy
Pupillary reaction
Pressure, intraocular
Acuity
Anterior chamber depth
Ancillary- Amsler Color Eversion
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34
Q

Define Emmetropia

Define Hyperpropia

A

Normal state, objects at infinity seen clearly w/ unaccommodated eye

Far sighted, axial length is short, image falls behind retina

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35
Q

Define Myopia

Define Astigmatism

Define Presbyopia

A

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

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36
Q

How does the curvature of glasses change for the different type of vision?

What are the other parts possibly seen in glasses prescriptions?

A

+ sphere: hyperopia
- sphere: myopia

Cylinder: astigmatism correction

Axis: astigmatism orientation for the eye

Prism- amount and direction

Bifocal- if needed for reading, always a +

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37
Q

How are lens prescriptions written?

What are the three types of eye deviations?

A

(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

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38
Q

Heterotropia is AKA ?

When is this condition is congenital, what happens?

What eye tends to have the worse vision?

A

Tropia

One eye suppressed to eliminate double vision

Most deviated has worse vision (amblyopia)

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39
Q

Define Strabismus

Define Phoria

Define Tropia

A

Misaligned eyes

Deviation only seen when one eye is covered

Deviation seen when both eyes are open/uncovered

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40
Q

Define Concomitant Strabismus

This type of deviation leads to ?

A

Non-paralytic strabismus
Misalignment equal in all directions of gaze w/ early onset

Bad vision acuity

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41
Q

Define Incomitant Strabismus

Define third, fourth and sixth vasculopathic tropias

A

Misalignment varies w/ direction of gaze due to nerve dysfunction or mechanical restriction

3: aneurysm
4: congenital trauma
6: cranial pressure

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42
Q

Define Nystagmus

What do most of the PTs with this condition suffer from?

A

Involuntary movement of eyes

Partial sightedness
Legally blind

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43
Q

What are the two classifications of nystagmus?

What are the two classifications based on eye movement patterns?

A

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

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44
Q

What are the four parts to a Hx when working up a nystagmus?

How are alternating nystagmus Tx

How are severe/disabling cases Tx

A

Infancy occular Hx
Drug/alcohol use
Vertigo
TBI

Baclofen- not for Peds

Retrobulbar botulinum injection

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45
Q

Define Amblyopia

These are AKA ?

A

Defected vision w/out detectable anatomic damage

Lazy eye

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46
Q

What are the four etiologies of amblyopia

A

Refractive: large uncorrected error (anisometropia)

Strabismus: deviated eye becomes amblyopic

Occlusion: ptosis/patching or media opacities

Organic: toxin, nutrition

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47
Q

How are amblyopias tested for at different ages?

What type of results are of low concern

A

<2: visual function
2-5: acuity picture cards

20/40 and equal eyes

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48
Q

How is strabismus testing done in PTs w/ amblyopia

What DDx may be considered?

What normal PE finding is poorly seen in these PTs?

A

Corneal light reflex test
Cover test

Epicanthus

Red reflex

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49
Q

What type of refractive error is more common in amblyopia

How are strabismus’ Tx in amblyopia PTs

A

Hyperopia

Patch better eye 2-6hrs/day
>11y/o- usually unsuccessful, polycarbonate lens

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50
Q

Surgical correction of strabismus’ are delayed until ?

Define Ec/Entropion

What are the Sxs of Ect/Entropion can include tearing d/t?

A

Vision is stabilized

Ec: lower lid turns out
En: lower lid turns in

Ec: punctal malposition
En: lashes abrading globe

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51
Q

What are the 4 etiologies of ectropion?

A

Paralytic: CN7 palsy

Involutional: lower lid laxity

Cicatricial: scarring

Mechanical: mass on lid/cheek

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52
Q

What are the two etiologies of entropion?

How are both Ect/Entroption Tx?

A

Involutional: lid laxity w/ age
Cicatricial: conjunctival scarring

Surgery

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53
Q

Define Lagophthalmos

What Sxs does this present w?

What will be seen on PE?

A

Inability to close eyes

Foreign sensation
Irritation
Tearing- failed lacrimal pump

Inability to close eyes
Exposed keratopathy

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54
Q

What are the 5 etiologies of lagophthalmos?

A 
Lower lid laxity w/ age
CN7 palsy
Proptosis
Over corrected ptosis/blepharoplasty from sugery
Lid trauma causing scars
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55
Q

How is lagophthalmos Tx

A

Mild: tears/gels/ointment
Tape eye close at bed

Mod/Sev: tarsorrhaphy, suture lids together, gold weight inserted under lid for permanent Tx

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56
Q

Define Ptosis

What are the presenting Sxs?

A

Drooping of upper lid

Obstructed upper vision
Difficulty reading
Secondary amblopyia (peds)
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57
Q

What are the etiologies of Ptosis

How are congenital/acquired cases Tx

A 
Congenital: abnormal levator
Acquired: thin/detached levator aponeurosis
Horners
CN3 Palsy w/ ophthalmoplegia
M Gravis

Surgery:
Tighten levator aponeurosis Resect levator muscle

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58
Q

Define Blepharitis

How does this present

A

Scaling of lid margin proximal to lashes

Photophobia Itching Burning
Epiphoria- excess tears

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59
Q

What are the MC causes of blepharitis

How is this Tx

A

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

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60
Q

Define Hordeolum

How are these caused?

A

AKA stye
Acute painful nodule

Staph infection
Sebaceous gland

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61
Q

How are hordeolums Tx

When are these referred to surgery?

What are the two adverse outcomes?

A

Warm compress/massage
Erythmycin ointment
PO Doxy if + blepharitis

Compress/ABX fail after 4wks
Need for rapid relief

En/Ectropion

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62
Q

Define Chalazion

What do PTs complain of at presentation

A

Lipogranulomatous inflammation from meibomian gland obstruction

Mildly tender

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63
Q

How are Chalazions Tx

When are these PTs referred to surgery?

A

Warm compress
Triamcinolone injection- c/i in dark complexion PTs

No resolution after 1mon
Incision and curettage of meibomian gland

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64
Q

Define Dacryocystitis

What are the presenting Sxs

What will be seen on PE?

A

Inflammation of lacrimal sac at nasal end of gland

Tearing Pain D/c

Erythema Preseptal cellulitis

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65
Q

What is the etiological cause of Dacryocystitis

How is this Tx

A

Bacterial infection
Nasolacrimal duct obstruction

Amox/Clavu 500mg PO q8hrs
Warm compress/massage
InD
Febrile= admit/IV ABX

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66
Q

When are dacryocystitis referred for surgical correction?

What is the name of the procedure?

A

Chronic
Once acute episode has resolved

Caryocystorhinostomy

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67
Q

Define Dacryoadenitis

What presenting Sxs will PTs have

What will be seen?

A

Inflammation of lacrimal gland

Swelling Pain Tearing

Swollen tender and erythematous gland

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68
Q

What three autoimmune issues can lead to dacryoadenitis

What two viral agents can rarely cause this?

A

Sarcoidosis Sjogrens Vasculitis

Mono Mumps

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69
Q

What is done during work up for dacryoadenitis

If unclear etiology, how is this Tx?

If infectious etiology, how is it Tx?

A

CT scan of orbit
Biopsy lacrimal gland

Systemic ABX, f/u q24hrs

Amox/Clavu: 500mg q8hrs
Cephalexin: 500mg q6hrs

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70
Q

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?

A

Basal cell
Squamous

Mohs removal (basal)

Radiation

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71
Q

Define the conjunctiva

What are the two

Define Fornix

A

Thin mucous membrane

Palpebral- inner eye lid
Bulbar- over sclera

Location where the two meet

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72
Q

What is the MC cause of viral conjunctivitis

How does this present?

A

Adenovirus

Preauricular adenopathy
Pink hue that usually spreads to unaffected eye
Watery d/c

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73
Q

How is viral conjunctivititis Tx

What PT education goes w/ this Dx

A

Cold compress/tears
Topical steroids if infiltrate/membrane present

ABX only if secondary infection
Highly contagious mid-7 days

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74
Q

What are the MC causes of bacterial conjunctiviits

What 3 DDxs need to always be considered?

A

Staph A
Strep pneumo
H Influenzae

N gonorrhea
N meningitidis
C trachomatis

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75
Q

If PT presents w/ the 3 DDx for bacterial conjunctivitis, what is the next step and why?

What are the Sxs of bacterial conjunctivitis?

A

Ophthalmology ASAP
Gonococcal ulcer perfs quickly

Lid adhesions
Beefy red/irritation
More likely unilateral

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76
Q

How are bacterial conjunctivitis cases worked up?

How is this Tx?

A

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

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77
Q

How is bacterial conjunctivitis Tx if Neirsseria has invaded cornea?

What can cause allergic conjunctivitis?

What type of hypersensitivity are these reactions?

A

Admit for IV ABX:
Ceftriaxone 1g IV q12hrs

Animal Molds Pollen

Type 1

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78
Q

How does allergic conjunctivitis present?

How are these cases Tx

What PO antihistamines can be tried?

A

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

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79
Q

How does subconjunctival hemorrhage present?

What medications can cause this?

A

ASx blood in one sector under conjunctiva

ASA
Warfarin

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80
Q

Subconjunctival hemorrhage presenting w/ ? Sxs needs an orbital CT?

How are these cases Tx

A

Proptosis
EOM restrictions
Elevated IOP

Tears
D/c elective ASA

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81
Q

Define Pinguecula and Pterygium

How are they similar?

How are they different?

A

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

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82
Q

How are Pingueculas/Pterygiums Tx

Define Phylctenule and what causes it

A

Tears/topical steroid (sev)
Surgery- ptery interferes w/ sight/visual axis

Nodular growth at limbus from bacterial protein (Staph) hypersensitivity

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83
Q

If unable to refer/evac PT w/ phylctenule, how are they Tx?

Define Conjunctival Nevus

These cases can but rarely develop into ?

A

Steroid/ABX combo: Tobra/Dexameth
Tobra/Lotaprednol

Benign/ASx pigmented lesion over sclera

Malignant melanoma; vascular network seen through conjunctiva

84
Q

How are conjunctival nevus Dx

What is the major concern in PTs presenting w/ conjunctival lacerations?

A

Biopsy necessary
Resected if suspicious

Ruptured globe
Retained foreign bodies

85
Q

How are conjunctival lacerations Tx

Define Thyroid Eye Dz

A

<1cm: Erythromycin oint TID
>1cm: surgical closure

Graves Ophthalmopathy but can be seen in hyper/po/euthyroid PTs too

86
Q

What is the MC cause of bilateral and unilateral ptosis in adults?

What work up is done and how is the Dx confirmed

A

Thyroid Eye Dz

Complete thyroid work up
Normal= careful monitoring
CT to confirm

87
Q

What phase of Thyroid Eye Dz does the upper eye lid retraction begin?

How are mild, mod and severe cases Tx

A

Early

Mild: tears, elevate head, tape lids at night
Mod/Sev: 
PO Prednisone
Decompression/radiation
Lid repair
Strabismus surgery
88
Q

What are the buzz word differentiators for the different types of conjunctivitis?

Any damage to cornea results in ?

A

Viral: preauricular adenopathy
Bacterial: mucopurulent d/c
Allergic: intense itches

Visual impairment

89
Q

Define Keratitis

What are the 5 layers of the cornea from out to in?

A

Inflammation of cornea

Epithelium
Bowman membrane
Stroma
Descemet's membrane
Endothelium
90
Q

How is erosion damage to the corneal epithelium seen on PE?

Corneal ulcer implies damage to ? layer

A

Sodium Fluorescein stain

Stromal damage from infiltrate

91
Q

What is the difference in presentation between bacterial/fungal and sterile infiltrates in corneal ulcers?

A

B/F: Extremely painful, aggressive
Blindness <48hrs

St: Minimal pain, most on peripheral cornea
Secondary to contact wear

92
Q

What are the S/Sxs of a HSV Keratitis ulcer?

What will be seen if it’s an advanced dz?

A

Epithelial dendrites
Photobphobia
Almost all- unilateral

Stromal scarring vascularization

93
Q

How is HSV Keratitis Tx

What is NOT given to these PTs?

A

Referral
Antivirals

Topical ulcers can cause ocular perforation/tissue loss

94
Q

Define Bacterial Keratitis

What are the MC microbes causing bacterial keratitis?

A

Bacterial colonization on cornea, interrupts intact corneal epithelium

Staph Strep Pseudo Morax Serratia

95
Q

What PT population is bacterial keratitis MC in ?

How is this Tx

A

Contact wearers w/ over night wear

Fluoroquinolone q1-2hrs
Tobra/Cipro if contact wearer
Daily monitoring
Vision threatened: fortified AB q30min

96
Q

What type of Hx highly suspects fungal keratitis?

What other Hx may suggest this?

A

Outdoor eye trauma w/ vegetative matter

Topical CCS use
Contacts
Recent surgery

97
Q

What is the MC presentation of fungal keratitis?

How are these cases Tx

What meds can be used for Tx

A

Feathery white opacity

Initial, same as bacterial
Refer to Ophth for culture
Surgical debrisment

Topical Natamycin/Amph B
Fluconazole
Voriconazole

98
Q

What med is c/i for Tx of fungal keratitis?

What drugs can cause corneal pigmentation?

What is the benefit of getting this issue?

A

Topical steroids

Hydroxy/Chloroquine- deposits
Amiodarone- whorl shaped
Phenothiazines
Indomethacin

Rarely causes vision loss
Most resolve w/ drug d/c

99
Q

What is the MC cause of recurrent corneal erosion?

How does this case present?

A

Dog claw

Mid-morning/late night onset of sudden/severe pain
“Sharp pain w/ eye open”
“Eyelid stuck to front of eye”

100
Q

How are recurrent corneal erosion Tx

When are these PTs referred to surgery?

A

Muro-128 ointment to dehydrate cornea at night
Tears during day
PO analgesic
Dilate to ease accommodation spasm

Severe, 90% success

101
Q

Define Keratoconus

If this becomes severe, it can lead to ?

A

Dz of unknown etiology causing thinning of central cornea
Leads to increased myopia, irregular astigmatism

Blindness
Corenal transplant

102
Q

Define Munson Sign

What other unique findings may be seen on PE?

A

Keratoconus- bulging lower lids from thinning central cornea bulge on inferior cornea

Fleischer RIng at base of cone

Vogt’s Striae

103
Q

Define Arcus Senilis

When does this condition go from normal aging process to abnormal finding?

What finding on PE confirms this Dx?

A

Gray/white deposits on peripheral cornea

Under 40, hyperlipoproteinemia

Clear area between deposit and limbus w/out vision changes

104
Q

What are the two functions of the sclera

What is it made of?

Where is the thickest point?

A

Protection
EOM attachment points

Collagen
Elastic fibers

Posterior aspect

105
Q

Episclera is connected to ?

What is the function of this attachment structure

A

Tenon’s capsule

Dense CT encasing globe
Sheath covering tendons at EOM insertions

106
Q

Episcleritis is more prevalent in ? but is MC ?

What d/os are associated w/ this eye issue?

A

Young adults
Idiopathic

HZoster
RA/Lupus
Rosacea
Thyroid dz
Syphilis
107
Q

How does episcleritis present

What is done during work up?

A

Acute sectorial presentation w/out d/c

Slit-lamp w/ anesthesia- Mobile vessel w/ CTA
Phenylephrine lets vessel blanch

108
Q

How is episcleritis Tx

A

Mild:
Cold compress/tears

Mod/Sev:
Fluorometholone
Ibuprofen
Loteprednol

109
Q

What CT Dzs can cause scleritis

What infections can cause it?

What is different about scleritis and what is the prominent feature?

A

Wegeners RA Ankylosing P nodosa Lupus

Herpes zoster
Syphilis

Older PTs
Severe/boring eye pain radiating to jaw/brow

110
Q

How is this condition classified?

A

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
Q

Posterior scleritis can cause ? injury to occur

How is scleritis different on PE?

What two examinations need to be done?

A

Exudative retinal detachment

Phenylephrine doesn’t allow blanching

Slit lamp w/ green light- r/o avascular areas
Fundus exam- r/o posterior scleritis

112
Q

How is diffuse/nodular scleritis PTs Tx

What meds are used if there is no improvement?

A

All referred to Ophth and:
NSAIDs
Ranitidine

Prednisone
Clophosphamide

113
Q

How is necrotizing sclertitis Tx

How is posterior scleritis Tx

A

Refer NSAIDs Rantidine and,
Clophosphamide
Perf= scleral patch graft

Controversial use of:
Cyclophosphamide
Rituximab
Glucocorticoids

114
Q

What are the three pats of the uveal tract?

When this tract becomes inflamed, what is the Dx w/ ? area of involvement?

A

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
Q

Anterior uveitis is AKA ?

What are the associated RFs for this Dz?

A

Iritis
Iridocyclitis

HLA-B27 (AS, Reiters)
JA
TB/Syphilis
Lymphoma

116
Q

What are the S/Sxs of anterior uveitis?

What might be seen on PE?

A

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
Q

How is anterior uveitis Tx

What is the prognosis difference for PTs w/ this Dx?

A

Clycloplegics:
Scopolamine- mild/mod
Atropine- severe

Topical steroid:
Prednisolone

First: non-granulous excellent
Repeat granulomatous- poor

118
Q

Posterior uveitis is a combo Dx of what 3 things

What is the MC cause?

A

Vitreitis
Choroiditis
Retinitis

Toxoplasmosis

119
Q

What is the MC severe infection affecting the eye?

What PT population does this occur in?

What happens if this is left untreated?

A

CMV retinitis

CD4<100

Blind <6mon

120
Q

What is the MC finding of CMV retinitis

What else may be seen on PE?

A

Cotton wool spots

Scotomata
Flashes w/ retinal detachment
Stellate shaped KPs

121
Q

How is CMV retinitis Tx

How is posterior uveitis Tx

A

HAART
PO Valganciclovir

Refer
Topical cycloplegic/steroid w/ anterior involvement

122
Q

How is non-necrotizing/posterior uveitis due to RA Tx

How is the necrotizing form Tx?

A

Tears
PO NSAIDs/steroids

No topical steroids
Scleral patch graft if high risk for perf

123
Q

What part of the body has the highest concentration of protein concentration?

What strctures are lacking here?

What are the 3 layers?

A

Lens

Blood vessels
Nerves

Capsule Cortex Nucleus

124
Q

What are the functions of the capsule?

What are the functions of the cortex?

A

Semipermeable membrane that envelopes/molds lens during accommodation

Produce lens cells, fibers for life
Older cells are deeper, lose organelles to become transparent

125
Q

What is the MC RF for developing cataracts?

What does the cataract have another MC with

A

Age

Cataract surgery- MC done in US

126
Q

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?

A

Nuclear sclerosis- yellow/brown discoloration

Blurry distance vision

Second sight of the aged, more myopic

127
Q

Define Posterior Subcapsular

What do PTs present complaining of?

What is the MC cause?

A

Opacities near posterior aspect of lens

Glare and difficulty reading

> 50y/o

128
Q

Define Cortical cataract

How does this present?

Why is this usually not seen in routine clinic?

A

Radial/spoke like opacities

ASx until central progressino, causes glare as MC Sx

Reqs pupil dilation

129
Q

What is the MC complaining Sx of cataracts?

What other Sxs/issues may be seen?

A

Progressive vision loss w/ glare from oncoming headlights

Monocular diplopia
Fixed spots in visual field
Dec color perception- blue hair dye

130
Q

How are catarcts Tx

Cataract surgery is done for ? reasons?

A

Early: spectacle prescription
Small central: pupil dilation
Late: surgical removal
Temporary benefit w/ Scopolamine

Glaucoma
Improve visual function
ARMD
Diabetic retinopathy

131
Q

Congenital cataracts are MC ?

This condition can potentially have ? sole presenting issue?

A

Idiopathic

Galactosemia

132
Q

What are the different types of congenital cataracts?

How can these present?

A

Posterior polar Coronary Lenticonus Sutural Lamellar
Anterior polar Blue dot

Dec vision
Infant squinting/eyes closed
Absent/abnormal red reflex

133
Q

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 ?

A

Maternal

Infant w/ cataracts- brain learns to see w/ macula during first 3-4mon

Deprivational amblyopia

134
Q

Define subluxation lens position anomaly

Define dislocation lens position displacement?

A

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

135
Q

What are the two MC causes of lens position anomalys?

What types occur and what is retained by the PT

A

Trauma- subluxation

Marfans Syndrome- superotemporal subluxation w/ retained accommodation

136
Q

What type of subluxation occurs w/ homocystinuria?

What is lost in this type of lens anomaly?

A

Inferonasal subluxation/dislocation

Accommodation lost

137
Q

Define Phacodonesis

Define Iridodonesis

Where are these issues seen?

A

Quivering lens

Quivering of iris

Lens position anomaly

138
Q

How is lens dislocation into anterior chamber Tx

How are lens subluxations Tx?

A

Replaced w/ head manipulation or surgery
ASx- observe
Significant Sxs- surgery

Surgery, only if PT has Sxs

139
Q

What is the MC cause of floaters?

What can cause an acute onset?

A

Age

DM/Sickle induced bleeding
Retinal tear
Int/Post uveitis
Posterior vitreous detachment
Foreign body
140
Q

If PT complains of flashes, what does this suggest?

What two things must be r/o?

A

Traction of vitreous on paripheral retina

Retinal detachment
Posterior vitreous detachment

141
Q

PTs w/ flashes and floaters mean ?

If PT presents w/ flashes and migraine, what can be seen?

A

Blood/pigment in vitreous

Scintillations
Zig-zag lights

142
Q

Define Weiss ring

How do PTs w/ vitreous opacities present?

A

Vitreous opacity seen by PT after vitreous detachment

Floaters
Blurry to severe vision loss

143
Q

Where is the fovea

Where does macula get blood supply from?

A

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
Q

How do arteries/veins differ in the retina on exam?

How do they cross each other in the eye?

A

Arteries- thinner, orange/red
Vein- larger, crimson

Arteries/veins cross each other
No V/V or A/A crossing

145
Q

What is the only place in the body vessels are visible w/out doing surgery

What structures supply blood to the retina

A

Retina

Central artery- inner retina
Choroid- outer retina and photo receptors d/t high O2 demand

146
Q

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?

A

Skin tone

Nerve fiber layer (to midbrain w/ pupillary response)
Ganglion cell layer

Optic chiasm to geniculate nucleus

147
Q

Retinal vascular ischemia issues manifest in ? layer

What will be seen on PE?

A

Nerve fiber layer

Opacification of inner retina - cotton wool spots in DM

148
Q

Retinal artery occlusion involving the branch of the retinal artery will present w/ ?

What part of the eye may be spared and why?

A

Horizontal hemifield vision loss

Macula- cilioretinal arteries from choroidal supply

149
Q

What are the RFs for retinal artery occlusion?

How does central retinal artery occlusion present?

What other RFs/Hx may be present

A

Lupus OCPs GCA

Unilateral painless acute vision loss

Light perception or worse
Afferent pupil defect
Hx of amoaurosis fugax

150
Q

What will be seen upon fundoscopic exam during central retinal artery occlusions?

How does branch retinal artery occlusions present?

A

Opacification/white retina
Cherry red spot in center
Box-car/segmented arterioles

Unilateral painless acute altitudinal/sectoral field loss

151
Q

What is different about the prognosis in BRAOs?

What is the first labs ordered for suspected CRAO/BRAOs?**

A

Permanent visual field defects
Rare neovascularization

Platelets ESR CRP**
PT >55y/o, r/o GCA

152
Q

How are CRAO/BRAOs Tx?

How are retinal vein occlusions going to present?

A

Ocular massage
Anterior paracentesis
Acetazolamide
Ophthalmic Timolol

Horizontal hemifield loss w/ respect to horizontal midline

153
Q

What causes retinal vein occlusions?

What is the biggest risk factor?

A

Thickened arterioles compressing veins causing stagnant outward flow

> 65y/o

154
Q

What will be seen on funcdoscopic exam of central retinal vein occlusions?

What are the two different types of occlusions?

A

Blood and Thunder fundus
Dilated veins
Swollen disc

Ischemic- cotton wool spots w/ extensive hemorrhage
Non-ischemic- mild fundus changes

155
Q

What is the prognosis of BRAO?

What can cause prognosis to be complicated?

A

Good, half develop collateral vessels

Chronic macula edema
Noevascularization

156
Q

How are retinal vein occlusions Tx

How are these PTs Tx if there is neovascularization or macular edema present?**

A

Ophtho eval <72hrs
D/c OCPs
Dec IOP

Intravitreal anti-VEGF** injection
PRP
ASA one x/day

157
Q

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 ?

A

<64- DM
>64- macular degeneration

6mon

158
Q

What type of DM rarely has retinopathy?

This benefit wears off though and is prevalent after how long?

A

Type 1

30yrs

159
Q

What are the RFs for diabetic neuropathy?

What hormonal influences can accelerate the retinopathy?

A 
Duration
Control
Pregnancy
HTN
Nephropathy

Pregnancy
Puberty

160
Q

What are the two types of diabetic neuropathy?**

What will be seen in each type?

A

Non-proliferatve:
Mild/Mod/Sev
Cotton wool Hemorrhage
IRMA Miroaneurysm Exudates

Proliferative**:
Late, new vessels grow at disc

161
Q

What may be seen during the 4 phases of non-proliferative diabetic neuropathy?

A

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
Q

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?

A

Neovascularization

Fragile vessels= recurrent hemorrhages

163
Q

What are the Sxs of proliferative diabetic retinopathy

What signs may be seen

A

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
Q

How is diabetic retinopathy Tx

A

NPDR- tight glucose control

+ Neovascular changes-
Anti-VEGF
PRP

165
Q

How does macular edema present?

What causes retinitis pigmentosa?

A

Gray/opacified retina
Micro-aneurysms
Dot/blot hemorrhage
Exudates

Loss of viable photoreceptors, initially rods
Retinal pigment changes

166
Q

How does Retinitis Pigmentosa present?

What signs may be seen on PE?

How is it Tx

A

Lost color/peripheral vision
Night blindness
Photopsia
Scotoma

Bone spicules
Golden-ring sign

Vit ADEK
Low vision aids

167
Q

What are the 3 types of retinal detachments

A

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
Q

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?

A

Flashes and floaters

Referral for complete dilated ocular exam

Red reflex from distance, detachment eye will be lighter

169
Q

How are rhegmatogenous retinal detachments Tx?

How are tractional detachments Tx?

A

Pneumatic retinopexy- intravitreal gas bubble w/ laster
Scleral buckle- silicone belt around globe

Pars plana vitrectomy

170
Q

What are the two different types of macular degeneration

What is the MC abnormality

A

Non-exudative, dry
Exudative, wet

Drusen- yellow deposits on retina, limits nutrition to photoreceptors

171
Q

What are the RFs for macular degeneration?

What are the S/Sxs of Dry AMD?

What will be seen on exam

A

Older female w/ light pigmentation who smokes and FamHx

Gradual loss of central vision

Macular drusen
Pigment clumps on outer retina

172
Q

What are the S/Sxs of Wet AMD

What will be seen on fundoscopic exam?

A

Distortion of straight lines- metamorphopsia
Rapid loss of central vision

Drusen
Neovascularization
Hemorrhages

173
Q

What are the RFs for progressing from Dry to Wet AMD?

A 
Age
Hyperopia
Blue eyes
FamHx
Larger drusens
Focal clumping
HTN
Smoking
174
Q

How is AMD Tx

A

Dry: Vit C E Beta-carotene Zinc
No Beta-carotene for smokers

Wet: Anti-VEGF
Laser photocoagulation

175
Q

What is the hallmark of hypertensive retinopathy

What else may be seen

A

Diffuse arteriolar narrowing

Copper wire vessel- arteriol narrowing
Silver wire- sclerosis
A:V ratios 1:3 or 1:4

176
Q

What are the Sxs of hypertensive retinopathy

What are the signs?

A

Scotomas
Double vision

Cotton wool spots
AV nicking

177
Q

How to tell hypertensive retinopathy from diabetic retinopathy

What are the S/Sxs of chloroquine toxicity

A

HTN- dry, more white than hemorrhage

Abnormal color vision
Difficulty adjusting to dark
Bulls-eye maculopathy

178
Q

How often do PTs on chloroquine need eye exams

When examining PT eyes, presence of hemorrhage indicates ? type of ARMD

A

Baseline w/in first year
Annually after 5yrs of use

Wet- needs anti-VGF

179
Q

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?

A

Retinal detachment

Rhegmatogenous

180
Q

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 ?

A

CRAO

Trabecular meshwork at junction of cornea/iris

Anterior chamber angle

181
Q

Where does aqueous humor exit the eye?

Define glaucoma

A

Schlemm’s canal

Progressive optic nerve damage and visual field loss

182
Q

What are the two categories of glaucoma

What measurement is used to assess the progression of glaucoma

A

Open angle- MC, normal outflow pathway
Angle closure- blockage of outflow

Cup to disc ratio
Smaller= less visible cup
Larger= more concern

183
Q

Define Ocular HTN

How is this Tx

A

Normal nerve
Normal anterior chamber
No visual field loss
IOP >21

Monitor annually

184
Q

Define Primary Open Angle Glaucoma

What two mechanisms can lead to this?

A

Loss of retinal fiver layer and reduction of vision

Vascular- optic nerve ischemia
Mechanical- cribiform plate compression

185
Q

What is the only modifiable RF against primary open angle glaucoma?

This condition may AKA ?

A

IOP >28

Thief in the night-

186
Q

What is the sequence of progressive vision loss seen in Primary Open Angle Glaucoma

What are the RFs for this condition

A

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
Q

What is not a RF for primary open angle glaucoma

What part of the day is IOP the highest

A

Systemic HTN

Morning

188
Q

Normal tension glaucoma is AKA ? and is a variant of ?

What will be seen?

A

Low tension glaucoma
POAG

IOP 21 or less
Open anterior chamber
Visual field/optic nerve damage

189
Q

What is a unique RF for normal tension glaucoma

What are the two mechanisms causing acute angle closure glaucoma

A

Obstructive sleep apnea

Relative pupil block- iris pushed forward
Non-pupil block- iris pulled/positioned anteriorly (inflammatory conditions)

190
Q

PT presents w/ intense ocular pain, photobia, N/V, what is the Dx

What precipitating event is seen?

A

Acute Angle Closure Glaucoma

Leaving movie theater

191
Q

How are AACG attacks stopped

What med is used if their IOP is <50?

What is the Tx of choice?

A

1 drop q5min of :
Timolol
Apraclonidine
Prednisolone/Dexameth

Acetazolamide 500mg IV

Laser iridotomy

192
Q

What causes Chronic ACGlaucoma?

How is this Tx

A

Anterior angle closed by peripheral anterior synechiae
(front of iris binds to corneal endothelium)

Trabeculectomy/tube shunt`

193
Q

PT presents w/ Port-Wine stain, what eye issue may be present?

What may be seen on the cornea during PE?

A

Sturge Weber syndrome presents w/ congenital glaucoma

Linear tears- Descenemet membrane
Haab striae- horizontal

194
Q

How is congenital glaucoma Tx

A

PO Acetazolamide
Topical Levobunolol/Timolol

Surgery-
Goniotomy
Trabeculotomy/ectomy/shunt

195
Q

Mother brings baby to clinic w/ complaint of squinting, blinking hard and IOP is 32. Dx?

What causes secondary glaucoma?

A

Congenital glaucoma

Males playing sports, has blunt trauma and experiences glaucoma at 10yrs

196
Q

What causes neovascular secondary glaucoma?

What will be seen on exam?

How is it Tx

A

Fibrovascular membrane grows into meshwork, slows drainage

Vessels growing into iris

Timolol, PRP

197
Q

Where/why wold steroid response glaucoma be seen?

Dx of glaucoma requires ? two things, otherwise its ? Dx

A

Refractive surgery

Reqs: optic nerve damage, progressive vision field loss
Ocular HTN

198
Q

Define Hemianopia

Define Homonymous

A

Loss of half of visual field

Visual field loss on same side of both eyes

199
Q

Define Scotoma

Define Anisocoria

A

Red/absent vision w/in intact visual field

Unequal size of pupils >1mm

200
Q

? and ? make up the photoreceptors in the retina

Where does initial visual processing and interpretation take place?

A

Nerve fiber layer
Optic nerve

Process: Retina
Interpret: visual cortex

201
Q

Where does the optic tract stop

This location is AKA ?

A

Lateral geniculate body

Neural way station, axons leave as optic radiations

202
Q

What type of vision occurs w/ lesion in chiasm?

Afferent pathway is CN ?
Efferent pathway is CN ?

A

Bitemporal heminopsia

A2
E3

203
Q

Double decussation is responsible for ? response

Marcus Gunn pupil is a ? defect and what occurs

A

Direct/consensual

Afferent
Light in good eye, normal constriction response
Shine light in bad eye, both pupils dilate

204
Q

What causes Adie’s Tonic pupil

What is seen on PE

Else would be seen on neuro PE

A

Denervatin of PNS supply to sphincter and ciliary muscle

Irregularly dilated, poor reaction to light
Slow accommodation

Dec/absent knee/ankle DTRs

205
Q

How is an Adie’s Tonic pupil Dx confirmed

A

Pilocarpine
Adies constriction
Normal pupils- no constriction

IPAP (212 decks)

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