Ophthalmology general Flashcards
Chemosis?
Accumulation of fluid under conjunctiva, the conjunctiva looks like a raised blister.
Ophthalmoplegia?
Paralysis of the extraocular muscles that control the movements of the eye.
Preseptal cellulitis is a clinical Dx once cellulitis has been excluded. Exclusion of orbital cellulitis is dependent on the absence of:
- proptosis
- ophthalmoplegia
- pain on eye movement
- impairment of visual acuity
Epiphora?
Watery eyes, excessive tearing.
Xerosis?
Conjunctival Dryness
Anisocoria?
Pupils of different sizes
PERRLA?
Pupils
Equal
Round
Reactive to
Light
Accomodation
Diagnostic position test?
Straight nasal = III = Medial rectus
Up and nasal = III = inferior oblique
Up and temporal = III = superior rectus
Straight temporal = VI (6) = lateral rectus
Down and temporal = III = inferior rectus
Down and nasal = IV (4) = Superior oblique
Exophthalmos?
Protruding eyes. AKA Proptosis (however proptosis can indicate any organ pushed foward)
Enophthalmos?
Sunken eyes.
Ectropion?
The lower eyelid is loose and rolling out.
Entropion?
Lower eye lid rolls in because of spams of lids or scar tissue. Scratching the cornea.
Blepharitis?
Inflammation of the eyelids.
Chalazion?
Inflammation of Meibomian gland.
Often painless and less erythematous than Stye
Hordeolum (stye)?
Painful!
External = infection of the glands in lid-margin (Gland of Zeis or gland of Moll)
Internal = Inflammation of meibomian gland
Dacryocystitis?
Dx: Nasolacrimal duct obstruction/inflammation.
Xanthelasma?
Dx: Soft, yellow plaques usually appearing symmetrically on medial aspect of eye lid.
Milia?
Dx: Pin-point multiple, firm, withe lesions.
Moderate to severe ocular pain DDX (Wills)?
- Corneal disorders
- Trauma
- Scleritis
- Anterior uveitis
- Endophthalmitis
- Acute angle closure glaucoma
Orbital pain DDX?
- Sinusitis
- Trauma
- orbital cellulitis
- Idiopathic orbital inflammatory syndrome
- Orbital tumor or mass
- Optic neuritis
- Acute dacryoadenitis
- diabetic cranial nerve palsy
- Cluster headache or migraine
- POst-infectious neuralgia (herpetic)
Episcleritis definition?
Episcleritis is inflammation of the tissue lying between the sclera (the tough, white, fiber layer covering the eye) and the conjunctiva (the membrane that lines the eyelid and covers the white of the eye).
Episcleritis diagnosis?
The diagnosis of episcleritis should be strongly suspected in a patient with a history of the abrupt onset of:
redness,
irritation, and
watering of the eye,
often without pain or mild pain (except in more chronic disease or with nodular episcleritis),
and with normal vision.
More common in women.
Sign: Sectoral (and, less commonly, diffuse) redness of one or both eyes, mostly due to engorgement of the episcleral vessels. These vessels are large, run in a radial direction beneath the conjunctiva, and can be moved with a cotton-tip applicator.
Scleritis definition?
Scleritis is severe, destructive inflammation of the sclera (the tough, white, fiber layer covering the eye) that may threaten vision.
Scleritis diagnosis?
Symptoms:
1. Severe and boring eye pain (most prominent feature),
2. which may radiate to the forehead, brow, jaw, or sinuses, and classically awakens the patient at night.
3. Pain worsens with eye movement and with touch.
4. Gradual or acute onset with red eye.
5. May have tearing, photophobia, or decrease in vision.
6. Recurrent episodes are common. Scleromalacia perforans (necrotizing scleritis without inflammation) may have minimal symptoms.
Signs: Critical.
1. Inflammation of scleral, episcleral, and conjunctival vessels (scleral vessels are large, deep vessels that cannot be moved with a cotton swab and do not blanch with topical 2.5% or 10% phenylephrine).
2. Can be sectoral, nodular, or diffuse with associated scleral edema. Characteristic violaceous scleral hue (best seen in natural light by gross inspection). Areas of scleral thinning or remodeling may appear with recurrent episodes, allowing underlying uvea to become visible or even bulge outward.
Uveal tract? 3 main part
- Choroid
- Ciliary body
- Iris
What is the Choroid?
the tissue layer filled with blood vessels between the sclera and the retina
What is the ciliary body?
the ring of tissue that contains muscles that change the shape of the lens and makes the clear fluid that fills the space between the cornea and the iris. It’s behind the iris.
What is the Iris?
The colored tissue at the front of the eye that contains the pupil in the center.
What is uveitis?
It’s the inflammation of the uveal tract = the iris/ciliary body and the choroid. There are 18 different types of uveitis.
Anterior uveitis (iritis/iridocyclitis) Signs and Sx?
Symptoms Acute: Pain, redness, photophobia, consensual photophobia (pain in the affected eye when a light is shone in the fellow eye), excessive tearing, decreased vision.
Signs:
The presence of leukocytes in the anterior chamber of the eye on slit lamp examination is characteristic of anterior uveitis, but is nonspecific (see ‘Differential diagnosis’ below). Leukocytes are not normally found in the aqueous humor that fills the space between the cornea and the lens. A haze, described by ophthalmologists as “flare,” may also be appreciated by slit-lamp examination and reflects protein accumulation in the aqueous humor secondary to disruption of the blood aqueous barrier.
What is endophthalmitis?
a purulent inflammation of the intraocular fluids (vitreous and aqueous) usually due to infection.
What is Panuveitis?
It’s a type of uveitis that is characterized by the inflammation of all 3 parts of the uveal tract: iris, ciliary body and choroid.
What is an endophthalmitis?
Endophthalmitis is an acute panuveitis resulting most often from bacterial infection.
Acute Angle Closure Glaucoma?
Angle-closure glaucoma is glaucoma associated with a physically obstructed anterior chamber angle, which may be chronic or, rarely, acute.
What is glaucoma?
Glaucomas are a group of eye disorders characterized by progressive optic nerve damage in which an important part is a relative increase in intraocular pressure (IOP) that can lead to irreversible loss of vision.
Acute Angle Closure Glaucoma S/S?
Symptoms:
Pain, blurred vision, coloured halos around lights, frontal headache, nausea, and vomiting.
Signs:
Critical: Closed angle in the involved eye, acutely increased IOP, microcystic corneal edema. Narrow or occlude angle in the fellow eye if of primary etiology. red eye.
Other: Conjunctival injection; fixed, mid-dilated pupil.
What is Keratitis?
An inflammation of the cornea.
What is Hutchison’s sign in ophthalmology?
The presence of vesicular lesions on the side of the nose
(nasociliary dermatome of V1) is associated with ocular
involvement.
amblyopia (AKA lazy eye)?
is reduced vision in one eye caused by abnormal visual development early in life. Often associated with Strabismus.
The neurodevelopmental defects associated with amblyopia are a result of lack of use of one or both eyes or a result of a long-standing defocused image.
Synechiae?
Ocular synechia is an eye condition where the iris adheres to either the cornea (i.e. anterior synechia) or lens (i.e. posterior synechia). Synechiae can be caused by ocular trauma, iritis or iridocyclitis and may lead to certain types of glaucoma.
What is consensual photophobia?
Direct photophobia refers to pain with light shone in the affected eye; whereas, consensual photophobia refers to pain with light shone in the unaffected eye. Consensual photophobia, though a subjective finding, is suggestive of iritis (anterior uveitis) over superficial corneal processes.
What is fixation?
Fixation is a reflex direction of the eye toward an object attracting our attention. The image is fixed in the center of the visual field, the fovea centralis. This consists of
very rapid ocular movements to put the target back on the fovea and somewhat slower (smooth pursuit) movements to track the target and keep its image on the fovea.
Myopia?
AKA Nearsighted, problem seeing far away.
Hyperopia?
AKA Farsighted, problem seeing close objects.
Pinguecula vs Pterygium?
Pinguecula and pterygium are fleshy growths on the conjunctiva (the membrane that lines the eyelid and covers the white of the eye). A pinguecula does not overlap the cornea (the clear layer in front of the iris and pupil), but a pterygium does.
What anatomy part are included in the Uvea?
Iris + ciliairy body + Choroid
What are the puncta or singular punctum?
Where tears drain, small opening in the eyelid.
Tono normal?
8-21 mmHg
What is keratoconjunctivitis?
Inflammation of the conjunctiva and the cornea.
What is symblepharon?
When the palpebral and bulbar conjunctiva adhere to one another.
Confrontation test?
This test screens for loss of peripheral vision. It compares the person’s peripheral vision with your own, assuming that yours is normal. Position yourself at eye level about 2 feet away. Looking straight at you, the person covers one eye with an opaque card (here the right eye) as you cover the opposite eye (here the left) (Fig. 14-11, A and B). You are testing the uncovered eye. Hold a wiggling finger as a target midline between you and the person and slowly advance it in from the periphery in several directions.
Monocular vs binocular diplopia?
Monocular = most likely eye issue/local issue
Bi = most likely neuro problem
To differentiate = in bi if close one eye the diplopia stops. In mono if affected eye stays open the diplopia stays.
Lateral penlight test?
100% of the Iris should light up, if Iris shadow there is probable IOP increase.
