Ophthalmology II highlights Flashcards
Open globe/ Ruptured globe:
1) What should you do if a pt comes in with this?
2) What is the Tx?
1) Requires emergent Ophthalmic consultation; do not put anything into the eye
2) CT scan of orbits, then IV antibiotics (per opthalmology)
Diabetic retinopathy:
1) Is it ever asymptomatic?
2) List 2 important Sx
1) Asymptomatic until late stages
2) Hemorrhages and cotton-wool spots
What condition majorly contributes to the importance of regular eye exams, especially for those with risk factors (DM, HTN)?
Retinopathy
Leading cause of preventable blindness is what?
Retinopathy
Blowout Fracture:
1) How is this diagnosed?
2) What does it require?
3) What is a significant consequence of fractures of the orbital floor? What can this cause?
1) CT imaging
2) Ophthalmology referral + hospitalization
3) Entrapment of the inferior rectus muscle and/or orbital fat.
-Muscle entrapment may lead to ischemia and subsequent loss of muscle function
Chemical ocular injury:
1) Do acids or alkaline substances usually cause more severe damage?
2) What is the Tx? What is commonly used in emergency departments?
1) Alkaline
2) Profuse continuous irrigation; Morgan lens
What condition is characterized by being asymptomatic until late stages, then presenting with the retinal findings of hemorrhages and cotton-wool spots?
Diabetic retinopathy
When should you screen for diabetic retinopathy in each type?
1) Type 1 DM: initial screening @ 5 years after diagnosis, then yearly or PRN
2) Type 2 DM: initial screening @ time of diagnosis, then yearly or PRN
1) Hypertensive retinopathy is related to what 2 things?
2) What do these lead to?
1) Arteriolar sclerosis and chronic elevated blood pressure
2) Ischemia
Hypertensive retinopathy:
1) Is it ever asymptomatic?
2) List 4 important Sx
1) Until late stages when vision is impaired
2) Copper/ silver wiring, flame-shaped hemorrhages, AV nicking, cotton wool spots
What condition is asymptomatic until later stages, and later has copper/ silver wiring, flame-shaped hemorrhages, AV nicking, or cotton wool spots on a retinal exam?
Hypertensive retinopathy
True or false: cotton wool spots can happen in both types of retinopathy
True
What could an absent red reflex or if pupil appears white (when light is shined upon it) indicate?
Retinoblastoma
1) What are some findings typical of severe hypertensive retinopathy?
2) What is the mainstay of treatment?
1) Moderate retinopathy findings plus papilledema
2) Control blood pressure and lipids
Optic cup: disc ratio > 0.5 is suggestive of what?
Chronic open-angle glaucoma
Optic neuritis:
1) Define it & give it’s main symptom
2) What are the other Sx?
3) What is the most common cause?
1) Acute inflammation of optic nerve; pain with eye movement
2) Acute onset of monocular vision loss/blurred vision and pain in affected eye
3) Multiple Sclerosis (MS)
Flame-shaped hemorrhages are characteristic of what stage of hypertensive retinopathy?
Moderate
Define papilledema
Swelling of the optic disc secondary to increased intracranial pressure
List 3 majors causes of chronic vision loss
Glaucoma
Cataracts
Age-related macular degeneration
What is normal IOP?
~10-21 mmHg
Chronic open-angle glaucoma:
1) What is NOT a valuable screening tool?
2) What is?
1) Measurement of IOP is not valuable
2) Elevated cup : disc ratio seen in fundoscopy
1) What type of glaucoma is a sight-threatening medical emergency?
2) Describe the Sx of this type
1) Acute angle-closure glaucoma
2) Acute, unilateral Sx
List 2 findings typical of optic neuritis on examination
1) Relative afferent pupillary defect (RAPD, also called Marcus Gunn Pupil)
2) Pupil dilates instead of constricts when light is swung to the eye
What is the classic triad of Acute angle-closure glaucoma Sx?
1) Red eye
2) Hazy cornea
3) Fixed, dilated pupil
Chronic open-angle glaucoma:
1) Define this condition
2) What % of glaucoma cases does it make up?
3) What is one way to diagnose it?
4) What is the classic Sx?
1) A gradual increase in IO
2) Common ~ 90% of glaucoma cases
3) Optic nerve damage [on fundoscopy]
4) Progressive peripheral vision loss that moves to central vision loss
Macular degeneration (AMD):
1) What is the key visual change?
2) What is the strongest modifiable risk factor for developing AMD?
1) Mostly affecting central vision
2) Smoking
1) What is the focus of Acute angle-closure glaucoma Tx?
2) What is the definitive Tx?
1) Decreasing IOP via decreased aqueous humor production
2) Laser peripheral iridotomy
Which 3 groups of glaucoma meds increase aqueous outflow/ drainage?
1) Cholinergic agents
2) Prostaglandin analogs
3) Alpha agonists (both mechanisms)
List the categories of glaucoma medications and give an example of each
1) Cholinergic agents
-Pilocarpine
2) Prostaglandin analogs
-Xalatan (latanoprost)
3) Beta blockers
-Timolol
4) Alpha agonists
-Brimodine
5) Carbonic anhydrase inhibitors (CAIS)
-Acetazolamide
1) Cataracts present with _________________ visual impairment.
2) What are 2 things you may see on exam of a cataract pt?
1) Slowly progressive
2) Diminished red reflex, may note clouding of lens
Chronic open-angle glaucoma:
1) Is it reversible?
2) What is the Tx focus?
1) Irreversible disease
2) Reducing IOP and maintaining normal ocular pressure
Which is greater in macular degeneration, central or peripheral vision loss?
Central
Drusen are associated with what?
Macular degeneration
Name one of the most successfully treated conditions in all of surgery
Cataracts
Giant cell arteritis:
1) Name 1 diagnostic study
2) How do you treat?
1) Elevated ESR (sed rate)
2) IV steroids (methylprednisolone), hospital admission for temporal artery biopsy
Cataracts:
1) What is a key visual change a pt might tell you?
2) What is it very closely related to?
1) Can’t see well at night
2) Age; most persons over the age of 70 will have some degree of cataracts
What are the 2 types of macular degeneration? Which is more common? Which is more acute?
1) Dry AMD: more common (chronic)
2) Wet AMD: less common (acute)
Macular degeneration:
1) What is a key thing you may see on fundoscopy?
2) What is a screening tool?
3) Who is it the most common cause of central visual loss & permanent blindness in?
1) Drusen
2) Amsler Grid test
3) Elderly
Giant cell arteritis:
1) What are 2 risk factors?
2) Who does it never occur in?
3) Why should it be treated?
1) Age (> 60-70 years old); Polymyalgia Rheumatica (PMR)
2) Never occurs in individuals under 50 years of age
3) Left untreated, can cause blindness
Painless, sudden vision loss described as a curtain-like shadow descending over the visual field is a hallmark of what?
Retinal detachment
What are two signs of retinoblastoma on PE?
1) Absent red reflex
2) If pupil appears white (when light is shined upon it)
Retinal detachment:
1) List 2 hallmark Sx descriptions
2) What does it often present with?
1) Painless, sudden vision loss
-A curtain-like shadow descending over the visual field
2) Peripheral field defect
True or false: retinal detachment is an ophthalmologic emergency
True
1) What is retinoblastoma?
2) Who is it most commonly found in?
1) Malignant eye cancer
2) Children
