Ophthalmology I (NOT on exam 1)

Question 1

HAPE review:
1) Define hyperopia
2) Define myopia
3) Define presbyopia

Answer 1

1) Farsightedness – can’t see closely
2) Nearsightedness – can’t see distance
3) Gradual, age-related farsightedness

Question 2

HAPE review:
What type of vision loss is very common hardening of the lens with aging that requires reading glasses?

Answer 2

Presbyopia

Question 3

HAPE review:
Define diplopia. What often causes it?

Answer 3

Double vision; often caused by a lesion of brainstem or cerebellum

Question 4

HAPE review:
1) List 2 things that could cause painless red eye
2) List 4 things that can cause painful red eye

Answer 4

1) Subconjunctival hemorrhage and viral conjunctivitis
2) -Acute angle-closure glaucoma
-Keratitis
-Foreign body
-Uveitis

Question 5

HAPE review:
List 5 potential causes of sudden, unilateral, and painless vision loss (hint: often vascular)

Answer 5

Vitreous hemorrhage (DM, trauma)
Macular degeneration
Retinal detachment
Retinal vascular occlusion
Central retinal artery occlusion

Question 6

HAPE review:
List 5 potential causes of sudden, unilateral, and painless vision loss (hint: think cornea and anterior chamber)

Answer 6

Acute angle-closure glaucoma
Corneal ulcer
Uveitis
Traumatic hyphema
Optic neuritis

Question 7

HAPE review:
List 3 potential causes of gradual vision loss (think more chronic)

Answer 7

Cataracts
Glaucoma
Macular degeneration

Question 8

HAPE review:
List the 2 locations of vision loss and potential causes of each

Answer 8

1) Central: Cataracts, macular degeneration
2) Peripheral: Chronic open-angle glaucoma

Question 9

True or false: Red eye is a common presenting symptom in primary care, and only a small % will need urgent ophthalmological referral/treatment

Answer 9

True

Question 10

What are some questions you should ask regarding a pt with a red eye complaint?

Answer 10

Is vision affected?
Is there pain that is acute in onset, progressive, and not relieved with analgesia?
Is there foreign body sensation?
Is there photophobia?
Recent trauma or injury?
Recent eye surgery?
Wear contact lenses?
Is there new onset of binocular double vision?
Is there discharge?

Question 11

Focused ocular Hx: What can the answer to “Is there pain?” tell you? (2 things)

Answer 11

Pain is:
1) Usually associated with inflammation (infectious or non-infectious)
2) Usually indicates anterior ocular structure (cornea, anterior chamber, anterior uvea)

Question 12

Focused ocular Hx: Why should you get PMHx?

Answer 12

Many medical conditions predispose to ocular pathology (DM, CAD, HTN, autoimmune disorders)

Question 13

What should you include in a focused ocular Hx?

Answer 13

1) Known ocular disease previously/surgeries
2) Contact lens use, glaucoma, diabetic retinopathy, intraocular surgery

Question 14

The human eye has four refractive media, these are?

Answer 14

Cornea, vitreous body, lens, and aqueous humor.

Question 15

List aspects of an eye exam

Answer 15

1) Testing visual acuity (sharpness of vision)
-The “vital signs” of the eyes
2) Testing visual fields
3) Inspection of the external structures
4) Evaluation of pupillary responses
5) Corneal light reflection/red reflex
6) Testing extraocular muscle function
7) Fundoscopy: Examining the retina, vasculature, optic disc, and fovea.
8) Tonometry (not usually in primary care)

Question 16

1) Define fovea
2) What is the fovea the central part of? What does this do?

Answer 16

1) The fovea centralis, or fovea, isa small depression within the neurosensory retina where visual acuity is the highest.
2) The fovea itself is the central portion of the macula, which is responsible for central vision. The macula, which is a part of the retina, is located at the back of the eye.

Question 17

1) What is Wood’s lamp?
2) Where is it freq. used?
3) What is it used for relating to the eyes?

Answer 17

1) A lamp that emits UV light that can detect skin pigment irregularities
2) Dermatology
3) To detect corneal abrasions or foreign bodies

Question 18

1) What is a Slit lamp?
2) What is needed to be done for this?
3) What can you visualize w this tool?

Answer 18

1) A specialized magnifying microscope which emits a narrow, but intense, beam of light used for examining the interior of the eye.
2) Eyes will need to be dilated with eye drops.
3) Able to visualize sclera, cornea, lens, retina, and optic nerve.

Question 19

List a bunch of common eye disorders

Answer 19

Ectropion/entropion
Hordeolum/stye
Chalazion
Blepharitis
Pinguecula
Pterygium
Dacryocystitis
Cataracts
Xanthelasma
Arcus senilis
Optic disc defects
Foreign body
Horner syndrome
Pupil changes (anisocoria)
Iritis
Conjunctivitis
Corneal ulcer/abrasion
Glaucoma
Lid defects
Field defects
Band keratopathy
Hyphema
Subconjunctival hemorrhage

Question 20

Entropion:
1) Define it
2) What are the Sx?
3) Where is it usually? Why does it usually occur?
4) Tx?

Answer 20

1) Eyelid margin (eyelashes) rotated inward – and rubbing against the eye.
2) Traumatizes the conjunctiva and cornea, causing tearing, irritation, redness, FB sensation, photophobia.
3) Lower lid, often due to aging
4) Artificial tears, lubricants until corrective oculoplastic surgery (or Botox injections).

Question 21

Ectropion:
1) Define it.
2) What does it cause?
3) What is it often due to and what is it associated with?

Answer 21

1) Eyelid margin rotated outward, away from the eyeball.
2) Exposes conjunctiva and cornea, which results in tearing, irritation, and redness.
3) Often due to aging; associated with obstructive sleep apnea (OSA).

Question 22

1) When ectropion is associated with OSA, what can occur?
1) Define this condition

Answer 22

1) Floppy eyelid syndrome
2) Both lids loose, resulting in conjunctivitis with significant discharge due to mechanical trauma to eyelids during sleep

Question 23

1) How is entropion treated?
2) What abt ectropion?

Answer 23

1) Artificial tears, lubricants until corrective oculoplastic surgery (or Botox injections).
2) Surgical repair

Question 24

Hordeolum/Stye:
1) Sx and demographic
2) What is it?
3) What does it look like on exam?
4) How is it treated?

Answer 24

1) Acute inflammation of the eyelid resulting in an erythematous tender lump in the eyelid. Commonly age 30-50 years old.
2) Infected pustule from an obstructed gland. Can be internal or external.
3) Tender, localized swelling of eyelid.
4) warm compresses (5-10 mins at least twice daily) in order to facilitate drainage. Also, massage and gentle wiping of eyelid.
-Antibiotics generally not indicated, but erythromycin ophthalmic ointment offers minimal risk.

Question 25

Hordeolum/Stye:
1) What organism is it most often associated with?
2) What should you do for non-resolving lesions (1-2 weeks)?

Answer 25

1) Staphylococcus aureus.
2) Refer to Ophthalmology for I&D

Question 26

Hordeolum/stye: explain the difference between the 2 types

Answer 26

1) Internal stye (meibomian glands)
2) External stye (ciliary glands)

Question 27

Chalazion:
1) Sx
2) Definition
3) What does it look like on exam?

Answer 27

1) Painless, localized swelling of the lid.
-Blepharitis is often associated.
-May follow a stye (initially tender).
2) Inflammation/obstruction of a meibomian gland resulting in rupture of glands into surrounding tissues and resulting granuloma.
3) Nontender rubbery nodule of the eyelid.

Question 28

Chalazion:
1) Tx
2) When should you involve an ophthalmologist?

Answer 28

1) Similar to a stye; conservative management (warm compresses). Antibiotic not indicated.
2) Often require I&D by ophthalmologist if not responding to treatment within 1-2 months

Question 29

Blepharitis:
1) Definition
2) Cause
3) Sx
4) What you see on an exam?

Answer 29

1) Chronic inflammation of the eye lid margin (without mass or pain) with associated irritation
2) Dysfunctional meibomian gland or staph infection
3) Itching, burning, tearing, FB sensation, crusting of eyelid margins
4) Eyelid margin erythematous, crust and debris within lashes, conjunctiva injected or mild mucus discharge

Question 30

What are 3 aspects of blepharitis Tx? When is each done?

Answer 30

1) Lid hygiene: BID warm compresses x 15 mins, gentle scrubbing with baby shampoo
-Lid massage, lid washing, artificial tears
2) Antibiotic ointment (due to staph) - Erythromycin ointment or bacitracin
3) If associated with acne rosacea/meibomian gland dysfunction – Doxycycline 100mg BID x one month

Question 31

Pinguecula:
1) What is it?
2) Sx?
3) What may happen periodically?

Answer 31

1) Elevated nodule on the either side of the eye (nasal side more common). Generally, does not encroach on visual field.
2) Presents as a small, raised, white or yellow colored growth limited to the conjunctiva. Contains deposits of fat, protein, and/or calcium.
3) May become inflamed, red, burning, itching sensation.

Question 32

Pinguecula:
1) Tx?
2) Prevention?

Answer 32

1) Artificial tears, lubricants, decongestants, topical anti-inflammatories.
2) Protect from UV, wind, and dust with sunglasses and hat.

Question 33

Pterygium:
1) Sx?
2) What two forms can it vary between?
3) What does it look like on exam? Where is it usually? Bilat or unilat?

Answer 33

1) Presents as wedge-shaped triangular growth of the conjunctiva on eye over the medial or lateral aspect of the cornea approaching the pupil, redness, irritation- “Pterodactyl”
2) Active and dormant
3) Superficial, fleshy, triangular-shaped growing fibrovascular mass
-Usually on the nasal side of eye; often bilateral

Question 34

Pterygium:
1) Tx?
2) Risk factors?
3) Prevention?

Answer 34

1) Small– lubricants, artificial tears, steroid drops.
-Can be removed surgically when vision impaired or EOM affected.
2) UV light, wind, dust, sand (chronic irritation). Also known as “surfer’s eye” (spend a lot of time in sun).
3) Sunglasses, artificial tears.

Question 35

Dacryocystitis:
1) Define it
2) What can cause it and what is it important to distinguish from?

Answer 35

1) Infection of the lacrimal sac (inferomedial region).
2) Inflammatory obstruction of the nasolacrimal duct; distinguish from periorbital cellulitis

Question 36

Dacryocystitis:
1) Who is it most commonly seen in?
2) Causes?
3) What test should you do? Then what should you do?

Answer 36

1) Most commonly seen in pediatrics.
2) Viral, bacterial, systemic diseases.
3) Massage lacrimal duct to express exudate for C&S.
Should be referred to ophthalmologist.

Question 37

Dacryocystitis:
1) List some common organisms that cause it
2) Tx?

Answer 37

1) Alpha-hemolytic streptococci,staphylococcus epidermidis, andstaphylococcus aureus.
2) Antibiotic therapy: Vancomycin (severe) or Clindamycin (mild)

Question 38

Orbital Cellulitis:
1) Define it
2) What commonly causes it?
3) What can it mimic?

Answer 38

1) Bacterial infection of the skin and surrounding soft tissues of the eye, orbit, and lids
2) Commonly caused by a sinus infection leading to subperiosteal abscess in the orbit
3) Dacryocystitis

Question 39

Orbital Cellulitis:
1) Sx?
2) Testing?
3) General Tx?

Answer 39

1) Redness, localized soft tissue swelling, warmth, pain, fever
2) CT imaging (with contrast)
3) Antibiotics (cover against community-acquired MRSA)

Question 40

Orbital Cellulitis: Describe the Tx in detail

Answer 40

Antibiotics (cover against community-acquired MRSA; staphylococcus aureus, streptococcus, Haemophilus influenzae):
1) Cephalexin 500mg PO QID x 5 days AND Bactrim DS (TMP/SMX) PO BID x 5 days
2) Clindamycin 450 mg PO TID x 7-10 days

Question 41

Xanthelasma:
1) Sx?
2) Demographic?
3) What’s it often associated with? What test should you do?

Answer 41

1) Soft, yellow plaques that usually appear symmetrically on the medical aspects of the eyelids. Painless and build up over time.
2) Common in middle-aged and older adults.
3) Often associated with hyperlipidemia (cholesterol build up) or congenital dyslipidemia.
-Get a lipid panel, especially in younger patients.

Question 42

Describe Tx for Xanthelasma. Is recurrence uncommon or common?

Answer 42

Treatment: do not generally require treatment. Surgical excision, laser therapy, or topical medications are available for cosmetic purposes.
Recurrence is common.

Question 43

Arcus Senilis (Corneal Arcus):
1) Sx
2) Causes?
3) Correlations/ associations?

Answer 43

1) a bluish, white, or light grey ring around the edge of the cornea.
2) An annular, yellow/white deposit on the peripheral cornea composed of lipids (cholesterol).
3) Correlated with shorter lifespans in women; associated with coronary artery disease.

Question 44

Arcus Senilis (Corneal Arcus):
1) Demographic?
2) Does it affect vision?
3) Tx?

Answer 44

1) Common with older adults.
2) Does not affect vision.
3) No definitive treatment – treat the underlying condition.

Question 45

1) Define ptsosis
2) What may it be a Sx of?
3) Can it obstruct vision? Explain

Answer 45

1) Drooping of the upper eyelid, generally resulting from a congenital or acquired abnormality of the muscles that elevate the eyelid (levator muscle).
2) May be a presenting sign/symptom of a serious neurological disease.
3) Can obstruct vision: It is a common cause of reversible peripheral vision loss that affects the superior visual field first and then can go on to affect central vision.

Question 46

Ptosis:
1) What do you need to determine?
2) List other causes
3) Tx?

Answer 46

1) Need to determine the underlying cause: is it myogenic (a muscular issue) or neurogenic (nervous system issue)?
2) Mechanical issue causing excessive weight on the eyelid (infections, inflammation, tumors, etc.) or complication of Botox therapy
3) Surgical correction.

Question 47

What are the two myogenic causes of ptosis? Which group of pts may experience amblyopia and strabismus; why?

Answer 47

1) Congenital abnormality of levator muscle (kids)
-Many experience amblyopia, strabismus bc levator muscle is weak from defect of innervation during development
2) Muscle disease (ex: muscular dystrophies, mitochondrial diseases)

Question 48

Aponeurotic ptosis
1) Define
2) What can it result from?

Answer 48

1) Isolated finding of ptosis
2) Trauma, chronic eye rubbing, or contact lens usage.

Question 49

List 3 neurogenic causes of ptosis and describe the Sx of each

Answer 49

1) Cranial III nerve palsy (oculomotor nerve): Pupil abnormality, Impaired extraocular movement in ipsilateral eye. If ipsilateral pupil is dilated, urgent evaluation for aneurysm is required.
2) Horner’s syndrome: Ipsilateral miotic pupil, Anhidrosis
3) Myasthenia gravis: Diplopia and extraocular movement abnormalities often present.

Question 50

Horner’s Syndrome:
1) Definition
2) What causes it?
3) What does it generally occur?
4) Tx?

Answer 50

1) Classic neurological syndrome that affects the face and eye on one side of the body
2) A disrupted nerve pathway (lesion anywhere along the sympathetic pathway that supplies the head, eye, and neck) on one side from the brain to the face/eye causes loss of sympathetic tone
3) As the result of another medical condition (ex: stroke, tumor, spinal cord injury, middle ear infection, etc.)
4) Treatment requires treating the underlying condition.

Question 51

Triad of Horner’s syndrome

Answer 51

1) Ipsilateral ptosis (drooping eye)
2) Miosis (pupil constriction)
3) Anhidrosis (sweat glands do not produce sweat)

Question 52

Pupil Changes (Anisocoria):
1) Definition & frequency
2) Sx?
3) Causes?
4) Hx and PE for this condition?

Answer 52

1) Impaired dilation or constriction of one pupil. Can be seen in approx. 20% of normal population.
2) Unequal pupil size.
3) Range from benign/normal to life-threatening (intracranial aneurysm).
4) Taking a thorough history becomes very important. Detailed physical exam includes both light and dark.

Question 53

List some common causes of Anisocoria

Answer 53

1) Horner syndrome
2) Adie pupil (tonic pupil)
3) Side effect of medications
-Topical ocular drops
-Scopolamine patch
-Aerosolized ipratropium
4) Certain plants (jimsonweed)

Question 54

Adie’s Tonic Pupil:
1) Definition
2) Is it benign? Who does it commonly occur in?
3) Unilateral or bilateral?

Answer 54

1) Parasympathetic denervation of ipsilateral pupil
2) Benign, idiopathic, primarily found in young women
3) Unilateral ~ 80% of cases

Question 55

Adie’s Tonic Pupil:
1) What does it look like under ordinary light?
2) What abt when responding to light?
3) What abt accommodation?

Answer 55

1) Tonic pupil larger than the uninvolved pupil initially
2) Response to light diminished or absent
3) Reaction to accommodation remains intact

Question 56

Adie’s Tonic Pupil:
1) Tx?
2) When is it called Holmes-Adie syndrome?

Answer 56

1) Instill weak cholinergic agent (0.1% pilocarpine – parasympathetic agent) will constrict the involved pupil indicating denervation hypersensitivity – normal pupil will not constrict.
2) When combined with hyporeflexia

Question 57

Conjunctivitis:
1) Sx?
2) What is it the most common cause of?
3) Define it

Answer 57

1) Inflammation of the conjunctival vessels (red eye), itching, irritation, discharge/crusting.
2) Most common cause of ‘red eye’.
3) Erythema of the palpebral or bulbar conjunctiva, very common.

Question 58

Conjunctivitis:
1) What is the most common cause? Describe the course
2) Tx?

Answer 58

1) Most often viral in nature (approx. 80-85%). Most resolve in 1-2 weeks. Self-limiting. Adenoviruses
2) Supportive care (cold compresses), isolation, hand hygiene.

Question 59

Bacterial conjunctivitis:
1) Sx?
2) Name 2 conditions it can be seen with

Answer 59

1) Less common, often purulent discharge. No itching.
2) Neisseria gonorrhoeae or chlamydia.

Question 60

How do you treat bacterial conjunctivitis?

Answer 60

Treat with broad-spectrum antibiotic eye drops/ointment:
1) Polymyxin B/trimethoprim sol. 1-2 drops every 3-6 hours x 7-10 days (Polytrim)
2) Erythromycin 0.5% ophthalmic ointment – 1 inch/ribbon applied to eye 4 times per day x 5-7 days
3) Levofloxacin/Moxifloxacin/Gatifloxacin 0.5% sol. 1-2 drops in affected eye every 2-4 hours x 5 days (fluoroquinolones)

Question 61

Describe the Sx and Tx of allergic conjunctivitis, and specify whether it’s more often unilateral or bilateral.

Answer 61

-Pruritis is most common, watering/tearing. Treat with antihistamines. More often bilateral.
-Allergy-related symptoms (itchy, watery eyes, runny nose, sneezing, etc.)

Question 62

Describe distinguishing between the 3 causes of conjunctivitis

Answer 62

1) Bacterial: thick purulent discharge that continues throughout day, usually unilateral (but can be bilateral).
2) Viral: presents as injection (diffuse redness), mucoid or serous discharge, and a burning, gritty feeling in one eye. -May be an isolated manifestation or part of a systematic viral illness.
-Second eye usually becomes involved within 24-48 hours. -Usually, profuse tearing rather than discharge.
-Symptoms generally worsen for 3-5 days and resolve over 1-2 weeks.
-Often the eye may be matted shut/crusted shut/stuck in the morning when waking due to overnight drainage. Usually clears away with wiping.
3) Allergic: generally bilateral redness. Watery discharge and itching.
-Itching is the cardinal symptom, distinguishing it from viral etiology (often have history of certain allergies and/or seasonal allergies).

Question 63

Conjunctivitis:
1) Describe the general measures of Tx
2) True or false: Most patients do not require antibiotics.
3) Can you treat empirically?

Answer 63

1) Highly contagious. Contact limitation is advised (make similar recommendations as you would for the common cold).
2) True
3) Yes, some providers may choose to treat empirically (Erythromycin, Trimethoprim, Ofloxacin, or Ciprofloxacin)

Question 64

1) Bacterial conjunctivitis Tx
2) Viral conjunctivitis Tx
3) Allergic conjunctivitis Tx

Answer 64

1) Antibiotic therapy is recommended
-Polymyxin B/trimethoprim or
Erythromycin 0.5% ophthalmic ointment or Levofloxacin/Moxifloxacin/Gatifloxacin 0.5%
2) Condition is self-limited. Topical antihistamine/decongestants and/or lubricating agents may provide symptom relief.
3) Antihistamines and/or mast cell stabilizers

Question 65

Iritis:
1) Definition and other name
2) What is it the most common type of?
3) What can cause it?

Answer 65

1) Inflammation of iris and/or ciliary body. Aka anterior uveitis
2) Most common type of uveitis (inflammation of uveal tract; incl. iris, ciliary body, and choroid).
3) Infection or inflammatory diseases (sarcoidosis, IBD (Crohn’s disease, ulcerative colitis), ankylosing spondylitis, lupus).

Question 66

Iritis:
1) Where is the redness?
2) What is the hallmark sign? Define it

Answer 66

1) Redness is primarily noted at the limbus (between cornea and sclera).
2) Ciliary flush: injection that gives appearance of a red ring around the iris.

Question 67

Iritis:
1) Symptoms
2) Treatment

Answer 67

1) Blurry vision, eye pain, redness, photophobia, constricted pupil.
-Does not have foreign body sensation
-Normal intraocular pressure.
2) Urgent referral to ophthalmology (topical steroids)

Question 68

Corneal Abrasion:
1) Sx
2) Test?

Answer 68

1) Acute onset of eye pain, reluctance to open eye with photophobia, foreign body sensation, eye redness, blurred vision, tearing associated with history of recent trauma.
2) Fluorescein staining with Wood’s lamp exam: highlights the corneal epithelium disruption

Question 69

Corneal abrasion:
1) What can be helpful to confirm diagnosis?
2) What can provide immediate relief in office?

Answer 69

1) Improvement of symptoms during exam can be helpful to confirm diagnosis.
2) Topical anesthetic for immediate relief in office (do not dispense) along with antibiotic eye drops to prevent infection.

Question 70

Describe Corneal Abrasion Tx

Answer 70

1) Topical antibiotic therapy to prevent superinfection is recommended:
-Ointment > drops because of lubrication
-Polymyxin B/bacitracin or Ciprofloxacin 0.3% antibiotic eye drops QID x 3-5 days
-Contact lens users: Fluoroquinolones (Oflaxacin or
Ciprofloxacin 0.3% QID for pseudomonas coverage (no contact lenses x 2 weeks)
2) Patching was previously used but is no longer recommended
3) Close follow-up until resolved. Many small abrasions will heal overnight.

Question 71

1) Define keratitis. What is usually the cause?
2) Define corneal ulcer

Answer 71

1) Inflammation of the cornea. Usually is the result of an infection (viral, bacterial, fungal).
2) Commonly referred to as keratitis, is an open sore on the cornea.

Question 72

Corneal Ulcer / Keratitis:
1) Sx
2) Risk factors
3) Can you see it during a PE? Describe Tx as well

Answer 72

1) Redness, severe pain, foreign body sensation, white spot on the cornea, tearing, blurred vision, photophobia
2) Contact lens usage
3) Can often be seen on physical exam; treat with antibiotic eye drops and urgent referral to Ophthalmology
-Discontinue use of contact lenses

Question 73

What is your first step when a pt comes in saying “something is in my eye” (i.e. FB)?

Answer 73

Get a thorough Hx:
Exposure to sand, grinding, metal, etc.?
Wearing protective eyewear?

Question 74

FB in eye:
1) Sx
2) What should you do if a corneal FB is detected? (Slit lamp is preferrable or Wood’s lamp exam + fluorescein stain)

Answer 74

1) Pain and foreign body sensation
2) Attempts can be made to remove it:
-Use irrigation after applying topical anesthetic eye drops
-Helpful with multiple small foreign bodies (ex: sand)
-Attempt can also be made to remove with a swab

Question 75

FB in eye:
1) True or false: Foreign bodies under the lid should be removed after everting the lid (flipping the lid)
2) When should you refer to an ophthalmologist?
3) Tx?

Answer 75

1) True
2) If severe or if unable to remove foreign body
3) Treat with topical antibiotic ointment (ex: erythromycin)

Question 76

Nevus and hydrocystoma are two examples of what?

Answer 76

Non-inflammatory eye defects

Question 77

Nevus:
1) Sx
2) When may it progress?
3) Do they have malignant potential? Explain
4) Tx?

Answer 77

1) well demarcated, flat or elevated, pigmented or non-pigmented congenital lesions
2) May progress during puberty or young adulthood (bigger, color change)
3) Junctional nevi (occurring @ junction between epidermis and dermis) have some malignant potential
4) Treatment: pigmented lesions that change in appearance should be excised/biopsied

Question 78

Hydrocystoma:
1) Sx?
2) They’re usually secondary to what?
3) Tx?

Answer 78

1) Translucent cyst located near eyelid margin
2) Occlusion of sweat glands of the lid
3) Complete excision

Question 79

Band Keratopathy:
1) Sx
2) How would you describe its appearance?
3) Is it common?

Answer 79

1) A corneal degeneration often composed of fine, dust-like calcium deposits in the cornea.
2) Horizontal, band-shaped growth from the peripheral cornea towards the central cornea.
3) No; rare finding

Question 80

Band Keratopathy can be associated underlying medical issues such as?

Answer 80

Multiple myeloma
Hyperparathyroidism
Sarcoidosis
Metastatic disease
Chronic renal failure.

Question 81

Banded keratopathy:
1) How’s it detected?
2) How’s it treated?

Answer 81

1) Upon slit lamp examination.
2) Can be managed conservatively at first or small surgical procedure to remove the corneal epithelium

Question 82

Traumatic hyphema:
1) What is it?
2) Sx?
3) Causes?

Answer 82

1) Accumulation of blood in the anterior chamber of the eye.
2) Photophobia, N/V, blurry vision, anisocoria, decreased visual acuity, elevated IOP
3) Blunt trauma to the eye (can be seen in children during sports activities) or penetrating trauma
-Baseball, softball, hockey puck, stick, racket, airsoft gun

Question 83

Traumatic hyphema:
1) May be a sign of what?
2) Can it result in permanent vision loss?
3) What two conditions may it result in?

Answer 83

1) Globe rupture or more serious ocular injury, lens subluxation, or retinal detachment
2) Yes
3) Acute elevated IOP and acute angle closure glaucoma

Question 84

How is traumatic hyphema treated?

Answer 84

Urgent referral to ophthalmology, need to exclude open globe injury

Question 85

Subconjunctival Hemorrhage:
1) Definition
2) Sx
3) Causes
4) Tx

Answer 85

1) Isolated hemorrhage, generally benign, in setting of minor trauma or injury.
-Acute collection of blood between conjunctiva and sclera.
2) Generally painless, asymptomatic otherwise. Normal vision.
3) Minor trauma, sneezing, coughing, heavy straining, vomiting.
4) Resolves spontaneously.

Question 86

1) Corneal ulcer is commonly referred to as what?
2) What is a hallmark Sx?
3) What’s a risk factor for this?
4) What are two key components of Tx?

Answer 86

1) Keratitis
2) Severe pain
3) Urgent referral to Ophthalmology; discontinue use of contact lenses

Question 87

Why should you not dispense topical anesthesia for prolonged or home use?

Answer 87

1) Inhibits healing
2) Rare allergic reaction
3) Eliminates corneal blink reflex; exposure of cornea, leading to dryness, trauma, infection.

Question 88

1) What should not be used by primary care unless in consultation with ophthalmology?
2) Why?

Answer 88

1) Topical ocular corticosteroids
2) Rarely prescribed by primary care; prolonged use may promote infection, lead to cataract formation, or elevation of IOP (glaucoma)

Question 89

Exophthalmos:
1) Sx?
2) Causes?
3) Tx?

Answer 89

1) Exophthalmos (proptosis) is the abnormal anterior protrusion of the eyes out of the orbit.
2) Commonly seen with Graves’ disease – hyperthyroidism.
3) Reverse the underlying hyperthyroidism and treat the thyroid disorder.
-Eyes can be treated with glucocorticoids as well as Teprotumumab to reduce the swelling/exophthalmos.

Question 90

A 7-year-old boy is brought to your clinic because he was hit in the eye with a ball while playing with his younger brother this morning. He has complained of pain in his eye ever since, and on examination you notice layered blood in the anterior chamber. Which of the following describes this abnormality?

a) Keratitis
b) Uveitis
c) Hyphema
d) Pterygium

Answer 90

Hyphema

Question 91

What are the 2 types of retinal artery occlusion>

Answer 91

Central Retinal Artery Occlusion (CRAO)
Branch Retinal artery occlusion (BRAO)

Question 92

1) What usually causes a retinal artery occlusion?
2) How do these pts usually present?
3) When can ischemia/thrombus develop in the renal artery?

Answer 92

1) Ischemia from thromboembolism of the retinal artery
2) Acute, painless, markedly impaired unilateral vison loss (amaurosis fugax)
3) Due to arteriosclerosis from cholesterol plaque formation and rupture

Question 93

List the risk factors for retinal artery occlusion (hint: often related to cardiac or carotid source)

Answer 93

1) PMHx of HTN
2) Cardiovascular disease (CVD)
3) Atrial fibrillation (source of embolus – carotid stenosis or heart)
4) Valvular disease
5) Carotid artery stenosis
6) Hollenhorst plaque: cholesterol emboli

Question 94

Define Amaurosis fugax

Answer 94

Sudden, short-term, painless loss of vision in one eye

Question 95

Retinal Vascular Occlusion:
1) What are two things you would see during an exam?
2) What vision differences would be present?
3) What does a dilated fundoscopic exam reveal?

Answer 95

1) Carotid bruit, irregular heart sounds
2) Markedly impaired monocular visio; visual field defect (dense scotoma); afferent pupillary defect (Marcus Gunn pupil)
3) Pale retina, cherry red spot in the fovea (fovea receives blood supply from choroid vs. surrounding retina from retinal artery)

Question 96

1) What is the goal of retinal vascular occlusion Tx?
2) What is the Tx?

Answer 96

1) Medical emergency to save vision; initiate treatment within 24 hours of event
2) Reduction of IOP: Timolol 0.5%, Acetazolamide 500 mg IV or PO
-Ocular massage (compress eye with heel of hand for cycles of 10 seconds on and off for 5 minutes – may dislodge embolus)
-AC paracentesis, catheter directed thrombolytics, hyperbaric oxygen chamber

Question 97

What do CRVO and BRVO mean?

Answer 97

CRVO = central retinal vein occlusion
BRVO = branch retinal vein occlusion

Question 98

CRVO/BRVOs (Retinal Vascular Occlusions):
1) Are they less or more common than CRAO/BRAOs?
2) What is the pathophysiology?
3) What are the risk factors?
4) How do these pts present?

Answer 98

1) More common than CRAO/BRAO
2) Compression of retinal vein via thrombus, AV nicking, extension of thrombophlebitis from cavernous sinus
3) Elderly with CAD risks: diabetes, HTN, and hypercoagulable states
4) Presents with subacute, painless, vision loss in one eye

Question 99

Retinal Vascular Occlusions:
1) What would you see on fundoscopic exam?
2) How do you Tx?

Answer 99

1) “Blood and thunder” retina: retinal hemorrhages and dilated veins, papilledema (optic disc swelling)
2) No effective medical treatment for prevention or treatment.
-There is some promising evidence of intravitreal injections of anti-VEGF to treat central vein occlusion.

Question 100

1) What is strabismus?
2) What does it usually result from?
3) What is esotropia commonly referred to as?

Answer 100

1) Misalignment of the eyes, causing one eye to deviate while the other eye remains focused.
2) Abnormality of the neuromuscular control of eye movement.
3) “Cross eyes”

Question 101

List 3 risk factors of strabismus

Answer 101

1) Strong correlation with family history: ~30% of children with strabismus having a family member with same condition
2) Pre-term birth or low birth weight
3) Other ocular conditions

Question 102

1) What question should you ask abt strabismus?
2) List common causes of strabismus

Answer 102

1) Is it congenital or acquired?
2) Cerebral palsy
-Down syndrome
-Hydrocephalus
-Retinoblastoma
-Stroke (leading cause in adults)
-Head injuries
-Graves’ disease

Question 103

1) Define exotropia
2) What are 3 treatments?

Answer 103

1) Form of strabismus (eye misalignment) in which one or both eyes turns outward.
2) Glasses, patching, surgery

Question 104

Exotropia:
1) When is it generally detected? What is it the opposite of?
2) Is it intermittent or constant?

Answer 104

1) Childhood; opposite of esotropia (‘crossed eyes’)
2) May be intermittent or constant

Question 105

Exotropia:
1) When intermittent exotropia occur?
2) Is it congenital or acquired?
3) Which is more common in infants: exotropia or esotropia?

Answer 105

1) When patient is tired/daydreaming or looking at a distance
2) May be congenital or acquired
3) Esotropia

Question 106

Amblyopia:
1) Define it
2) What’s it commonly referred to as?
3) Is it unilateral or bilateral? Who is it seen in?

Answer 106

1) Functional reduction of visual acuity by abnormal visual development early in life.
2) “Lazy eye”
3) Generally unilateral, seen mostly in children

Question 107

Amblyopia:
1) Define it
2) What is it different from?
3) What can be a symptom of it?

Answer 107

1) When the eye does not have normal visual acuity
2) Not the same as strabismus (which is eye alignment)
3) Strabismus can be a symptom of amblyopia

Question 108

Define amblyopia
1) When does it occur?
2) What is it the most common cause of?
3) When is screening for this recommended?
4) What should you do when a pt has it?

Answer 108

1) When nerve pathways between the brain and an eye aren’t properly stimulated, the brain favors the other eye
2) Pediatric visual impairment (1-4% of children)
3) All children under 5 years of age
4) Refer to ophthalmology/optometry

Question 109

Nystagmus:
1) What is it?/ How does it present?
2) Is it bilateral or unilateral?
3) Horizontal or vertical?
4) Fast or slow?

Answer 109

1) Patient presents with involuntary, rapid, repetitive movement of both eyes
2) Typically bilateral
3) Often horizontal (may be vertical or rotary)
4) Varies between fast and slow

Question 110

Congenital nystagmus:
1) What may it be a sign of in infancy? What may it lead to?
2) Is it treatable?
3) What do you need to rule out (2 things)

Answer 110

1) May be a sign of visual impairment, strabismus, and may lead to amblyopia
2) Generally not treatable
3) Impaired vision and amblyopia

Question 111

Acquired nystagmus:
1) When does it occur? Describe
-How would you treat it?
2) What are some examples of causes?

Answer 111

1) Later in life, variety of causes, bothersome to patient
-Treat the underlying cause if found
2) Neurological issues, vertigo, medications (Gabapentin, Baclofen), refer to PT/OT