Ophthalmology I scenarios Flashcards
Painless, localized swelling of the eyelid with blepharitis is associated with what? How’s it treated?
Chalazion; conservative management (warm compresses). Antibiotic not indicated.
A pt comes in with a FB sensation in their eye and crust on their eyelid margins. They have what?
Blepharitis
A 40 year old comes into your clinic with the CC of an erythematous tender lump in the eyelid.
1) What is your Dx?
2) What is the most common cause of this Dx?
3) How do you Tx?
1) Hordeolum/Stye
2) Staphylococcus aureus.
3) Antibiotics generally not indicated, but erythromycin can be used
A pt was diagnosed with a stye. Eventually it went away and was followed by the appearance of tender rubbery nodule that became painless. What do they have?
Chalazion
Crust and debris within lashes is the main Sx of what? How’s it treated?
Blepharitis; lid hygiene (and Erythromycin if due to staph)
An 8 year old comes in with a raised, red mass on the inner corner of the eye.
1) This is likely what?
2) How do you Tx?
1) Dacryocystitis (aka lacrimal sac infection)
2) Vancomycin (severe) or Clindamycin (mild)
A presents with a small, raised, white or yellow colored growth limited to the conjunctiva. It occasionally is accompanied with an itching and burning sensation.
This is a description of what condition? How is it treated?
Pinguecula; artificial tears, lubricants, decongestants, topical anti-inflammatories.
Which should you refer to an ophthalmologist first if it’s not resolving, a pt with a stye, or a pt with a chalazion?
A pt with a stye should be referred after 1-2 wks, a chalazion within 1-2 months
A pt has acne rosacea and is now experiencing blepharitis. How do you Tx?
Doxycycline 100mg BID x one month
Protection from UV can help prevent what two eye conditions?
Pinguecula and Pterygium
Why should you massage lacrimal duct to express exudate when a pt has dacrocystitis?
C&S (to tailor antibiotics)
A pt has all the Sx of dacryocystitis. What do you need to make sure they don’t have instead?
Periorbital cellulitis
Which is more likely to be on the margin of the eyelid, a stye or a chalazion?
Stye
Your pt just got botox, but now they have drooping of the upper eyelid. What do they have and what is the Tx?
Ptosis; wait for botox to wear off (or surgery if permanent)
A pt has a dysfunctional meibomian gland or staph infection. They are likely to develop what?
Blepharitis (eyelid margin inflammation)
A pt, who previously had as sinus infection, now has redness, localized soft tissue swelling around the orbital region accompanied by warmth and pain. The pt also has a fever. What is your next move?
CT imaging (with contrast) to distinguish b/t orbital and periorbital cellulitis.
You get a pt’s CT scan w. contrast back and Dx them with orbital cellulitis. What are 3 of the likely causes?
Staphylococcus aureus, streptococcus, Haemophilus influenzae
A pt has orbital cellulitis. What are you 2 main Tx options?
1) Cephalexin x 5 days AND Bactrim DS (TMP/SMX) x 5 days
or
2) Clindamycin x 7-10 days
Your 65 year old pt has soft, yellow, symmetrical, painless plaques on the medial aspects of the eyelids.
1) What is your Dx?
2) Tx?
1) Xanthelasma
2) Do not generally require treatment. Surgical excision, laser therapy, or topical medications are available for cosmetic purposes. Recurrence is common.
A surfer comes in your office with a superficial, fleshy, triangular-shaped growing fibrovascular (reddish) mass on the medial side of their eye.
They have what condition? What is it likely from?
Pterygium; UV light, wind, dust, sand (chronic irritation).
(this condition is also known as “surfer’s eye”)
A 22y/o pt comes in with clear Xanthelasma on their eyelids. What should you be concerned abt?
Xanthelasma is often associated with hyperlipidemia (cholesterol build up) or congenital dyslipidemia.
Get a lipid panel.
A bluish, white, or light grey ring around the edge of the cornea is called what? What causes this?
Arcus Senilis (Corneal Arcus); composed of lipids (cholesterol).
Your older pt has a corneal arcus. What are they more likely to have?
Coronary artery disease
A pt clearly has ptosis, and you know you need to figure out which of the two potential causes it’s from. What are these causes?
Neurogenic and myogenic
A pt has ptosis, miosis, and anhidrosis on one side of the face. What is your Dx and what is the cause?
Horner’s syndrome, loss of sympathetic tone due to another condition (ex: stroke, tumor, spinal cord injury, middle ear infection, etc.) interrupting pathway
A pt has a dilated pupil, ptosis, and impaired EOMs in the same eye. What do you need to do?
Urgent eval for aneurysm
After performing a full PE on a pt you note an isolated finding of ptosis. What type of ptosis is this, and what are some likely causes?
Aponeurotic ptosis; can result from trauma, chronic eye rubbing, or contact lens usage.
An 18y/o female pt presents with a tonic pupil larger than the uninvolved pupil (when in normal light). The affected eye’s response to light is diminished or absent, but reaction to accommodation remains intact.
She likely has what? How can you test this?
Adie’s Tonic Pupil; Instill weak cholinergic agent (0.1% pilocarpine; parasymp. agent) will constrict the involved pupil indicating denervation hypersensitivity, normal pupil will not constrict.
A pt presents with Adies tonic pupil and hyporeflexia. This is called what?
Holmes-Adie syndrome
What type of conjunctivitis is more often bilateral? How is it treated?
Allergic; antihistamines and/or mast cell stabilizers
A pt has unequal pupil size. This is called what?
Anisocoria
If a pt has amblyopia (lazy eye) and ptosis, you know their ptosis is likely of what origin?
Myogenic
A pt has itching and discharge/ crusting of the eye with erythema of the conjunctiva. The most common cause of this is what?
Conjunctivitis (is the most common cause of red eye), specifically viral conjunctivitis
What is the key feature to differentiate bacterial and viral conjunctivitis?
Bacterial discharge is more likely to be purulent
A pt has profuse tearing of one eye with burning and diffuse redness. The second eye begins to experience the same Sx approx. 30 hours later, and both eyes are matted shut with discharge.
1) What is the likely Dx?
2) Tx?
1) Viral conjunctivitis
2) Condition is self-limited. Topical antihistamine/ decongestants and/or lubricating agents may provide symptom relief.
If a pt has Horner’s syndrome or Myasthenia gravis, they’re at risk for what kind of ptosis?
Neurogenic
What condition will you commonly see in pts with Graves’ disease (hyperthyroidism)? What are they also at risk for?
Exophthalmos (proptosis); Strabismus
A pt has acute onset of eye pain, reluctance to open eye with photophobia, foreign body sensation, eye redness, & blurred vision.
1) What is the likely Dx?
2) How can you confirm this?
1) Corneal Abrasion
2) Fluorescein staining with Wood’s lamp exam
A pt has ciliary flush (a red ring around iris), burning, and pain of the eye. There is no FB sensation. What is the Dx and Tx?
Iritis (inflammation of iris and/or ciliary body. Also known as anterior uveitis.)
-Urgent referral to ophthalmology (topical steroids)
How long should you tell your contact-wearing pt to abstain from wearing them after a corneal abrasion?
2 wks
Your pt, who wears contacts, is having eye redness, severe pain, foreign body sensation, and there’s a white spot on their cornea.
1) You know their contact lens usage has put them at risk for the condition they have, which is what?
2) What should you tell them to do?
1) Keratitis
2) D/c contact usage
When should you refer a FB pt to an ophthalmologist?
If severe or if unable to remove foreign body
A 4 y/o presents with irritation of one eye with purulent discharge, but no itching. What is the likely Dx and what are 3 ways to Tx?
Bacterial conjunctivitis:
1) Polymyxin B/trimethoprim
2) Erythromycin 0.5% ophthalmic ointment
3) Levofloxacin/Moxifloxacin/Gatifloxacin 0.5%
If a pt complains of a foreign body sensation, what do you need to do?
Take a thorough Hx (to figure out if it’s likely actually a FB or not)
A pt has a well demarcated, flat or elevated, pigmented congenital lesion. What is it likely to be and when does it need to be treated?
Nevus; pigmented lesions that change in appearance should be excised/biopsied
A pt has a translucent cyst located near eyelid margin. What is it and you do you Tx then?
Hydrocystoma; complete excision
The most common cause of pediatric visual impairment (1-4%) that you should screen all your pts under 5 for is what?
Amblyopia
You examine your pt with multiple myeloma with a slit lamp and notice horizontal, band-shaped growth from the peripheral cornea towards the central cornea.
1) What is their likely (hint: rare) Dx?
2) What is likely the cause?
3) Tx?
1) Band Keratopathy
2) Corneal degeneration often composed of fine, dust-like calcium deposits in the cornea.
3) Can be managed conservatively at first or small surgical procedure to remove the corneal epithelium
A pt has a lazy eye. What makes it “Amblyopia”?
If there’s a functional reduction in visual acuity
A pt has blood in the anterior chamber of the eye. This is called what?
Hyphema
If your pt has a Hx of HTN, CVD, or Hollenhorst plaque (cholesterol emboli), what ocular condition are they at risk for?
Retinal Artery Occlusion
A dilated fundoscopic exam of your pt with HTN and amaurosis fugax in one eye reveals pale retina, cherry red spot in the fovea. What is your Dx and Tx?
Retinal artery occlusion; medical emergency to save vision, reduction of IOP via Timolol 0.5%, Acetazolamide 500 mg IV or PO and ocular massage
-AC paracentesis, catheter directed thrombolytics, hyperbaric oxygen chamber also options
What can develop in a pts retinal artery due to arteriosclerosis from cholesterol plaque formation and rupture?
Ischemia/thrombus in retinal artery
A pt has misalignment of the eyes, and so did their parent. This is describing what condition?
Strabismus
What should you not prescribe to your pts with eye problems in primary care without consulting with ophthalmology first?
Topical ocular corticosteroids
Amaurosis fugax is a Sx of what serious condition?
Retinal artery occlusion
Intermittent _____________ can occur when patient is tired/daydreaming or looking at a distance
exotropia
Your 65 year old pt has strabismus. What’s the most likely cause?
Stroke
Your pt’s eyes are crossed. What’s the medical term for this?
Esotropia
1) Subacute, painless, vision loss in one eye describes the Sx of what?
2) What would you expect to see on a fundoscopic exam?
1) Retinal vein occlusion
2) “Blood and thunder” retina – retinal hemorrhages and dilated veins, papilledema (optic disc swelling)
Which should you expect to see more in infants, esotropia or exotropia?
Esotropia
True or false: strabismus can be a symptom of amblyopia
True
