Ophthalmology Clinical Correlation

Question 0

How many people get cataracts?

Answer 0

Everyone

Age related

Question 1

What are the big three eye diseases?

Answer 1

Cataracts
Macular degeneration
Glaucoma

Question 2

What are indications of cataract surgery?

Answer 2

Severe visual loss

Functional needs

Driving

Question 3

What is macular degeneration?

Answer 3

Age related, over 50
Central vision loss

Two types:
Dry
Wet

Question 4

What do you see in dry macular degeneration?

Answer 4

Pigment changes

Drusen

Question 5

What is exudate (dry) macular degeneration?

Answer 5

Defects develop in deep layers of the retina
Growth of blood vessels under the retina, edema, and finally hemmorhage

Dry can become wet

Scarring can happen and blinding

Question 6

How do you treat macular degeneration?

Answer 6

Stop smoking

Dry: eat veges, nutrition, AREDS (age related eye disease study) supplements,

Wet: above, plus conventional laser, photodynamic therapy. Anti vegf drugs (vessel formation)

Question 7

What are some causes and symptoms of glaucoma?

Answer 7

Increased intercranial pressure causes optic nerve loss

Any age, mainly after 40

Question 8

What are the two main types of glaucoma?

Answer 8

Open angle
Closed angle (narrow)

Question 9

What is the treatment of glaucoma?

Answer 9

Lower eye pressure

Medical, surgical, laser

Question 10

What is the place where the iris meets the eye?

Answer 10

The angle

Question 11

What happens on open angle glaucoma?

Answer 11

Trabecular mesh work leading to schlemms canal is the main blockage

Thicker and less open with age

Question 12

What allows you to quantify optic nerve tissue?

Answer 12

Optical coherence tomography

Question 13

What is acute/narrow angle glaucoma and what is a main symptom?

Answer 13

Painful
Acute emergency
Loss of vision
Feels hard
Nausea
Iris is pushed up against the canal

Question 14

What are symptoms of narrow angle glaucoma?

Answer 14

Pain, photophobia, blur, halo around lights

Corneal edema

Question 15

How do you treat closed angle glaucoma?

Answer 15

Pilocarpine (know!!!)

Acetazolamide

Question 16

How do you treat closed angle glaucoma per neatly?

Answer 16

Laser iridotomy

Question 17

What is diabetic retinopathy like?

Answer 17

Mild to severe
Slow progressive
Can cause total blindness

Question 18

What is the pathophysiology of diabetic retinopathy?

Answer 18

Alterations in pericytes
Micro-occlusions
Retinal ischemia 
VEGF upregulation
Angiogenesis
Hemorrhage 
Organization into scar tissue
Traction (detachment)

Question 19

What are the two main kinds of diabetic retinopathy?

Answer 19

Nonprolierative diabetic retinopathy (NPDR)

Proliferative diabetic retinopathy (PDR)

Question 20

What is NPDR?

Answer 20

Blot hemorrhages
Cotton wool spots
Macular edemhard exudates
Micro aneurysms

Question 21

What do you see in the eye in NPDR?

Answer 21

Cotton wool spots

Question 22

What do you use to see NPDR?

Answer 22

Fluoresce in angiogram

Question 23

What heals diabetic retinopathy?

Answer 23

Insulin

Question 24

What is characteristic of PPDR?

Answer 24

More significant than NPDR | Hemmorhage boat hemmorhage

Question 25

How do you treat PPDR?

Answer 25

Panretinal photocoagulation (PRP) Coagulate the vessels with a laser 1000-15,000 spots Wipe out the supportive retina

Question 26

How often do diabetics get an eye exam?

Answer 26

Yearly eye exam | 5 years within diagnosis of type 1

Question 27

What is hypertensive retinopathy?

Answer 27

Narrowing and sclerosis of the arterioles Cotton wool spots Flame hemmorhage Optic nerve edema in severe cases

Question 28

Where do you see narrowing of the arterioles?

Answer 28

Hypertensive retinopathy

Question 29

How do you treat hypertensive retinopathy?

Answer 29

Control blood pressure If bad can use PRP Panretinal photocoagulation is vascular occlusion

Question 30

What is Amaurosis Fugax?

Answer 30

``` Sudden loss of vision in one eye Lasts only minutes Painless Impending stroke until proven otherwise Temporary vascular insufficiency ```

Question 31

What do you do when you see Amaurosis Fugax?

Answer 31

CV work up first | Ophthalmology work up second

Question 32

What is the work up for Amaurosis Fugax?

Answer 32

Physical exam Carotid ultrasound Echocardiogram

Question 33

What is an Hollenhorst Plaque?

Answer 33

Embolic material within retinal arteriole Corotid artery or heart valve orgin Eventually dissolve

Question 34

What is an ophthalmic migraine?

Answer 34

``` Scintillating scotoma (aura) -painless, temp - bilateral -short Spasm of arteriole in the occipital cortex ```

Question 35

What is a ophthalmic migraine treatment?

Answer 35

Normal treatment

Question 36

What is characteristic of retinal detachment?

Answer 36

``` Sudden partial vision loss in one eye Painless Floaters are often Higher freq in myopia Trauma, spontaneous ```

Question 37

How do you treat retinal detachment?

Answer 37

Buckle around the eye

Question 38

What is characteristic in retinal arterial occlusion?

Answer 38

Classic sign is cherry red spot Usually permanent loss Occlusion in the retinal artery behind the eye

Question 39

How do you manage acute arterial occlusion?

Answer 39

Re breathing CO2 push clot further out, blood vessel gets bigger Low eye blood pressure Message the eye Needle in the eye

Question 40

What are characteristics of retinal vein occlusion?

Answer 40

Not as urgent Treat underlying conditions Not CV but hyper coagulation

Question 41

What show a squashed tomato picture in the eye?

Answer 41

Center retinal vein occlusion

Question 42

What is temporal arthritis?

Answer 42

NOT PAINLESS Wind hurts ``` Have weight loss Fever Whole body aches Jaw cramps Inflammatory vision loss Can die from stroke ```

Question 43

What do you see in temporal arteritis?

Answer 43

Swollen and white optic nerve

Question 44

How do you diagnosis temporal arteritis?

Answer 44

Sedimentation ESR C-reactive protein

Question 45

How do you initially treat temporal arteritis?

Answer 45

High dose of systemic steroid immediately | Early

Question 46

What is classic in temporal arteritis?

Answer 46

Multi nucleated giant cells Fragmentation/disruption of the elastic lamina of the blood vessels Skip lesions

Question 47

What is key with a visual cerebrovascular accident?

Answer 47

Bilateral | Look at visual field

Question 48

Do you ever use topical anesthetic?

Answer 48

Only temp | It makes things worse

Question 49

What is highly associated with viral conjunctivitis?

Answer 49

Preauricular lymphadenopathy