Ophthalmology I highlights Flashcards
1) What is important to do if a pt comes in with anisocoria (unequal pupils)?
2) What is important to include during PE?
3) Name a common cause
1) Thorough Hx taking
2) Light and dark
3) Scopolamine patch
What is Holmes-Adie syndrome?
Tonic pupil (Adie’s tonic pupil) and hyporeflexia
What condition constricts both pupils?
Argyll Robertson pupil
1) What abnormal pupil finding is benign, idiopathic, & primarily found in young women?
2) What makes this finding unique?
3) What would a weak cholinergic agent do to an eye with this? Why?
1) Adie’s tonic pupil
2) Reaction to accommodation remains intact
3) Involved pupil will constrict, indicating denervation hypersensitivity
1) What is the most common cause of ‘red eye’?
2) Is this more commonly viral or bacterial? How long does this form last?
1) Conjunctivitis
2) Most often viral in nature (approx. 80-85%). Most resolve in 1-2 weeks. Self-limiting.
1) What helps distinguish bacterial conjunctivitis from viral?
2) What helps differentiate allergic conjunctivitis?
1) Bacterial often has purulent discharge
2) Allergic is more often bilateral, watery discharge
Unilateral thick purulent discharge is characteristic of what kind of conjunctivitis?
Bacterial
“Second eye usually becomes involved within 24-48 hours. Usually, profuse tearing rather than discharge” describes what kind of conjunctivitis?
Viral conjunctivitis
True or false: Most pts with conjunctivitis do not require antibiotics
True
For bacterial conjunctivitis, what is recommended? Be specific
Antibiotic therapy:
1) Polymyxin B/trimethoprim or
2) Erythromycin or
3) Levofloxacin/Moxifloxacin/Gatifloxacin
1) What is the hallmark sign of iritis?
2) List 3 more Sx
1) Ciliary flush
2) Eye pain, redness, and constricted pupil
Describe allergic conjunctivitis and give its cardinal symptom
1) Generally bilateral redness. Watery discharge + itching.
2) Itching
1) What are two key Sx of corneal abrasion?
2) What testing is done?
1) Reluctance to open eye with photophobia and Rx of recent trauma to eye
2) Fluorescein staining with Wood’s lamp exam
What should you tell contact wearers with a corneal abrasion?
No contact lenses x 2 weeks
True or false: Corneal abrasion pts always get antibiotics
True
Foreign body sensation is a primary Sx of what?
Foreign body
When should you refer a corneal FB pt to an opthalmologist?
If severe or unable to remove FB
What should you not dispense for prolonged or home use?
Topical anesthesia (ophthalmic)
Can you use topical ocular corticosteroids as a PCP?
Should not be used by primary care unless in consultation with ophthalmology.
Calcium deposits in the cornea in a band shape are a Sx of what condition?
Band keratopathy
1) What is the name for blood in the anterior chamber of the eye?
2) What can it result in?
1) Traumatic hyphema
2) Permanent vision loss
How is a retinal artery occlusion treated?
Medical emergency to save vision; reduction of IOP is the goal
How do you treat subconjunctival hemorrhage?
Resolves spontaneously.
What condition is commonly seen with Graves’ disease – hyperthyroidism?
Exophthalmos
What are the 2 types of retinal vascular occlusion?
Central and branch
1) What is misalignment of the eyes called?
2) Who is more likely to have it?
1) Strabismus; “cross eyes”
2) Strong correlation with family history
What are the two main onsets of nystagmus?
Congenital and acquired
When a pt has a retinal artery occlusion, dilated fundoscopic exam reveals what?
Pale retina, cherry red spot in the fovea
Retinal Artery Occlusion
1) What is it usually attributed to?
2) What is a common visual symptom?
3) What are 3 potential causes?
1) Ischemia from thromboembolism of the retinal artery
2) Amaurosis fugax
3) PMHx of HTN, cardiovascular disease (CVD), Hollenhorst plaque (cholesterol emboli)
Subacute, painless, vision loss in one eye is characteristic of what?
Retinal vein occlusion
What are the two primary categories of red eyes?
Painless and painful
One or both eyes turning outward is called?
Exotropia
1) Most common cause of pediatric visual impairment (1-4% of children) is what? What is it also called?
2) When is screening recommended for this?
1) Amblyopia; a “lazy eye” (does not have normal visual acuity)
2) In all children under 5 years of age
Differentiate the 2 categories of unilateral vision loss
1) Sudden, unilateral, and painless (often vascular)
2) Sudden, unilateral, and painful
List 3 causes of gradual vision loss
Cataracts
Glaucoma
Macular degeneration
What are two primary locations of vision loss?
1) Central (cataracts, macular degeneration)
2) Peripheral (chronic open-angle glaucoma)
1) List a common presenting ocular symptom in primary care
2) Will a large of small % of these need urgent ophthalmological referral/treatment?
1) Red eyes
2) Small %
List an important ocular Hx question to ask
Is there pain?
The human eye has four refractive media, list them
1) Cornea
2) Vitreous body
3) Lens
4) Aqueous humor.
The small depression within the neurosensory retina where visual acuity is the highest is called what?
fovea
1) Who’s most at risk for entropion? Where is it most likely?
2) What abt ectropion?
1) Often due to aging; lower lid
1) Associated with obstructive sleep apnea (OSA) (also often due to aging)
-Floppy eyelid syndrome
1) What is entropion?
2) What is ectropion?
1) Entropion: eyelid margin (eyelashes) rotated inwar and rubbing against the eye.
2) Ectropion: eyelid margin rotated outward, away from the eyeball.
1) Describe entropion Sx
2) Describe ectropion Sx
1) Traumatizes the conjunctiva and cornea, causing tearing, irritation, redness, FB sensation, photophobia.
2) Exposes conjunctiva and cornea, which results in tearing, irritation, and redness.
1) Entropion Tx?
2) Ectropion Tx?
1) Artificial tears, lubricants until corrective oculoplastic surgery (or Botox injections).
2) Surgical repair
Hordeolum/Stye:
1) Main symptom?
2) What would you see on exam?
3) What is the general Tx?
4) What is it most often associated with?
1) Tender lump in the eyelid
2) Tender, localized swelling of eyelid.
3) Antibiotics generally not indicated
4) Staphylococcus aureus.
Chalazion:
1) Main symptom?
2) What would you see on an exam?
1) Painless swelling/ bump of eyelid
2) Nontender rubbery nodule of eyelid
Blepharitis:
1) What would you see on exam?
2) What is the main component of Tx?
3) What abt if due to staph?
1) Crust and debris within lashes
2) Lid hygiene
3) Erythromycin ointment or bacitracin
List 3 organisms that often cause orbital cellulitis
1) Staphylococcus aureus
2) Streptococcus
3) Haemophilus influenzae
What is a primary characteristic of pingueculas?
Generally, does not encroach on visual field
Pterygium
1) What would you see on an exam?
2) Where is it usually?
1) Superficial, fleshy, triangular-shaped growing fibrovascular mass
2) On the nasal side of eye
1) It is important to distinguish Dacryocystitis from what?
2) Who is it most common in?
3) How should you treat?
1) Distinguish from periorbital cellulitis
2) Pediatrics.
3) Refer to ophthalmologist and start PO antibiotics
What are some orbital cellulitis Sx?
1) Redness
2) Localized soft tissue swelling
3) Warmth, pain, fever
-I.e. more systemic Sx than dacrocystitis
1) What testing should you do for orbital cellulitis?
2) Most common Tx?
1) CT imaging (with contrast)
2) Cephalexin
What is an ocular condition often associated with hyperlipidemia?
Xanthelasma
What two conditions can be related to cholesterol issues?
Xanthelasma and Arcus Senilis (Corneal Arcus)
Arcus Senilis (Corneal Arcus):
1) What is this ring made of?
2) Who’s it most common in?
1) Cholesterol
2) Older adults
1) What pt of the body does Horner’s syndrome affect?
2) What generally causes it?
1) Face and eye on one side of the body
2) Another medical condition
What is an indication for urgent evaluation if the pt also has ptosis? Why?
Ipsilateral pupil dilation; could be aneurysm (affecting CNIII)
A brown ring around the iris is called what? What can it be caused by?
Kayser-Fleischer Ring; Wilson’s disease
Amblyopia belongs to what group of causes of ptosis?
Myogenic
1) Define ptosis
2) What are two types of underlying causes?
3) Is it reversable?
1) Drooping of the upper eyelid
2) Myogenic or neurogenic
3) Generally yes
Triad of Sx for Horner’s syndrome is what?
1) Ipsilateral ptosis (drooping eye)
2) Miosis (pupil constriction)
3) Anhidrosis (sweat glands do not produce sweat)
