OPHTHALMOLOGY

Question 1

What is hyphema? -treatment? -major possible long-term complication?

Answer 1

Blood in the anterior chamber of the eye from blunt or perforating trauma -treatment: rest, NO MOVEMENT AT ALL because might increase risk of rebleeding and increased intraocular pressure 1. Bedrest 2. HOB elevated 3. May need hospitalization and sedation if kid is freaking out 4. Can use topical steroids to decrease risk of rebleeding 5. In rebleeding, may need to evacuate clot Major complication: increased risk of glaucoma

Question 2

What is amblyopia? -types? (4) -treatment modalities?

Answer 2

Lack of clear image on the retina 1. Strabismus amblyopia: confusing image! Due to poor aim 2. Anisometropic amblyopia: unequal need for vision correction between the eyes 3. amytropic amblyopia: blurry image! high refractive error in both eyes 4. Deprivation amblyopia: no image due to poor clarity and something blocking the light and affecting ability to focus (ie. cataracts) Treatment depends on cause of amblyopia: refer to ophtho! -opacify the good eye or do pharmacological penalization with atropine drops

Question 3

What percentage of the population have different sized pupils?

Answer 3

25% = anisocoria -should make sure they have normal pupillary light reflex

Question 4

Which sport is the most common cause of eye injury?

Answer 4

Baseball

Question 5

What is the differential diagnosis for esotropia? (3)

Answer 5

1. Congenital -starts less than 6 months -tends to have refractive errors -refer to ophtho 2. Accommodative -have difficulty focusing on object -3-6 yo -amblyopia is present -uncorrected far-sightedness 3. 6th nerve palsy from congenital, meningitis, increased ICP (tumor, idiopathic intracranial hypertension)

Question 6

When would you refer a child with esotropia or exotropia to an ophthalmologist? -what are SCARY causes of esotropia/exotropia?

Answer 6

If constant, need to refer asap! -if intermittent, need to refer by 4 months of age -scary causes: cranial nerve palsy, brain tumors

Question 7

What is the treatment of a corneal abrasion?

Answer 7

1. Topical cycloplegic agent to relieve pain from ciliary spasm (not for home use) = ONLY for slit lamp exam 2. Topical antibiotic ointment until healed (do not use topical aminoglycosides or topical steroids as this increases risk of corneal ulceration) ****do not use semipressure patch since it can itself abrade the cornea and doesn’t help healing time

Question 8

What is a hordeolum? What is a chalazion? -usual causative organism or hordeolum? -treatment? -mom asks if you are going to incise her kid’s hordeolum. What do you say?

Answer 8

:Hordeolum: stye in your eye! Blockage of Meibomian gland with an infection (glands at base of eyelid where eyelashes are -chalazion: blockage of meibomian gland WITHOUT infection. -usual causative organism of stye = staph aureus -Treatment: frequent warm compresses +/- PO abx (topical abx are not useful) -do NOT I&D stye when it is acutely infected since this will increase the risk of periorbital cellulitis -can I&D chalazion

Question 9

How can you differentiate between ptosis caused by CN3 palsy vs. Horner syndrome?

Answer 9

CN3 palsy = causes SEVERE ptosis Horner syndrome (sympathetic fibres) = causes mild ptosis CN3 = think of the 3 roman columns holding up your eyelid with the sympathetics doing a tiny bit of the work on top of the columns

Question 10

A 5 mo baby presents to you with ptosis. Her mother says she has been this way since birth. Her extraocular movements and pupillary light reflexes are normal. What is your diagnosis?

Answer 10

Congenital dystrophy of levator palpebrae superioris muscle = innervated by CN3 which is working normally but the muscle is not functioning

Question 11

What is the most common source of infection for periorbital cellulitis? What about orbital cellulitis?

Answer 11

Periorbital cellulitis is USUALLY from an external infection (ie. scratch in the skin) whereas orbital cellulitis is USUALLY from an internal infection (ie. from sinusitis!!!)

Question 12

What is blepharitis? -what is a possible complication of blepharitis?

Answer 12

Swelling of the eyelid at the eyelashes= Meibomian gland blockage = see dandruff on eye lid -possible complication: corneal ulcer

Question 13

What is the management for nasolacrimal duct obstruction? -when is ophtho consult indicated? -what percentage self resolve?

Answer 13

1. Warm compresses 2. Pump 10x at tear duct prior to each feed (since pumping the tear duct will make baby cry, then can soothe and comfort them with feeding) -consult ophtho if no resolution post 1 yo = then can probe through the puncta/cannicula and create an opening for tears to drain -80-90% self-resolve

Question 14

What is the treatment for dacryocystocele? -what age group is this most likely seen in compared to nasolacrimal duct obstruction? -complication of untreated?

Answer 14

Infected and inflammed nasolacrimal duct secondary to complete blockage and bacterial trapping -usually seen within first 2 weeks of life (whereas nasolacrimal duct obstruction that is narrowed but still draining tears, parents usually bring their babies in later on, like a few months of age) -treatment: 1. IV abs +/- surgical drainage (needed 50% of the time) -complication: can compress nares and cause resp distress

Question 15

What is the treatment for viral conjunctivitis? (3)

Answer 15

1. Artificial tears 2. Cold compresses 3. ENCOURAGE HAND HYGIENE AS VERY CONTAGIOUS

Question 16

What are 2 complications of untreated anterior uveitis? -treatment for anterior uveitis?

Answer 16

1. Increased IOP 2. Cataracts -treatment: 1. PO steroids +/- topical steroids

Question 17

A healthy 3 mo boy has anisocoria. His right pupil is slightly smaller than the left. Which of the following findings would suggest Horner syndrome of the right eye? a. Severe right upper eyelid ptosis b. right iris appears lighter in color than the left c. mild right proptosis d. optic disc edema in the right eye e. limited abduction in the right eye

Answer 17

B! Heterochromia can be seen in Horner syndrome if it is congenital…don’t know why…iris color can apparently be sympathetically driven

Question 18

A mother brings her baby to you with concerns about vision. She reports that her baby sleeps during the day all the time and only opens his eyes in dim light. Also she notices he has “big beautiful eyes”. What is your diagnosis?

Answer 18

Congenital glaucoma! Increased ocular pressure secondary to impaired fluid drainage leads to expansion of the eye, cornea gets cloudy, expands and then the baby gets photophobia too

Question 19

What is the approach to the treatment of strabismus?

Answer 19

1. Check vision of both eyes. If vision is equal, then this means amblyopia has not developed secondary to the strabismus = can go straight to surgery 2. If vision is unequal, then this is amblyopia and need to patch the good eye first so that the eye with the amblyopia can improve its vision first. Then can do surgery.

Question 20

What is pseudoesotropia?

Answer 20

Excess skin at the medial canthus makes the pupils look crooked BUT if you look at the pupils using a light, the corneal light reflex will be symmetrical and cover/uncover test will be normal

Question 21

What is myopia? Heteropia?

Answer 21

Myopia = near sighted! (MN) Heterotrpia = far sighted (H`F) -letters closer together

Question 22

What are risk factors for congenital sensorineural hearing loss?

Answer 22

ABCDS 1. Affected family member 2. Bilirubin (kernicterus) 3. Congenital TORCH infections 4. Defects of the ear, nose and throat 5. Small at birth (prem, bw < 1500 g)

Question 23

What is the most common genetic cause of sensorineural hearing loss?

Answer 23

Connexin 26 protein defect from mutation = autosomal recessive