Ophthalmology in Primary Care Lecture Powerpoint

Question 1

Corneal abrasion

Answer 1

Patient presents with pain, tearing, and photophobia second to corneal epithelium trauma, clinically diagnosed with fluorscein dye stain, treat with topical antibiotics because increased risk of infection, use topical erythromycin , most of time does not require patching unless large abrasion

Question 2

Upon removal of foreign body from the eye need referral to ophthalmology to remove..

Answer 2

….residual rust ring

Question 3

Morgan lens

Answer 3

Contact lens that is connected to IV tube that irrigates the lid and the corneal surface to flush out eyes after chemical burn until pH returns to normal

Question 4

Numbness in cheeks and upper lip suggests ___ fracture, numbness in eyebrow and forehead suggests ___ fracture

Answer 4

floor, roof

Question 5

Chalazion (stye)

Answer 5

Blocked meibomian gland or eyelash hair follicle? that presents with a wel defined, subcunaeous nodule within the eyelid

Question 6

A Chalazion (stye) is NOT a ____

Answer 6

infectious process, don’t need antibiotics

Question 7

Chalazion treatment (3)

Answer 7

• Warm compresses to eyelid
• doxy BID for its anti oil properties (like acne meds)
• intralesional injection of steroids

Question 8

Dacryocystis treatment (4)

Answer 8

• oral antibiotics augmentin
• IV if severe
• warm compress
• referral for I&D

Question 9

Preseptal cellulitis lacks these 4 things compared to orbital cellulitis

Answer 9

• no conjunctival redness
• no pain with eye movement
• no restriction of extraocular mobility
• Can treat outpatient instead of admit for IV antibiotics in hospital

Question 10

Herpes zoster ophthalmicus affects what dermatome?

Answer 10

V1 (ophthalmic division of trigem)

Question 11

Hutchinson’s sign

Answer 11

A rash that involves the nose that predicts herpes zoster ophthalmicus and other diseases associated from this

Question 12

Typical treatment for bacterial conjunctivitis (2)

Answer 12

• moxifloxacin

- ofloxacin

Question 13

“True” pink eye

Answer 13

Viral induced conjunctivitis, watery, droopy lid, pinkish coloration

Question 14

Clinical sign: Inferior tarsal conjunctival follicles

Answer 14

Pale, dome shaped nodules tender upon palpation in the area around the eye indicative of viral conjunctivitis

Question 15

Clinical sign: Upper tarsal conjunctival papillae

Answer 15

Small flattened nodules with a central vascular core see on the upper lid indicative of allergic conjunctivitis

Question 16

3 topical mast cell stabilizers for allergic conjunctivitis

Answer 16

• zaditor
• alaway
• pataday

Question 17

In patients with allergic conjunctivitis want to avoid ____ products because _____

Answer 17

“get the red out”, rebound hyperemia when stopped

Question 18

Contact lens overwear can cause 2 possible conditions

Answer 18

• non infectious overwear can cause vascularity to grow in the cornea
• infectious leads to corneal ulcer

Question 19

Most common cause of bacterial corneal ulcer

Answer 19

Improper contact lens wear/care

Question 20

Clinical sign: Dendritic branching staining pattern on flurescin staining of eye

Answer 20

Herpes simplex virus

Question 21

Elderly patient with “red eye” with nausea and vomiting likely indicates…

Answer 21

….high intraocular pressure

Question 22

Definitive reatment for acute angle closure glaucoma

Answer 22

Laser peripheral iridotomy

Question 23

Clinical sign: Leukocoria

Answer 23

When a white pupillary reflex is noted rather than normal on a fundoscopic exam which can indicate malignant lethal tumor called retinoblastoma, assume tumor until proven otherwise

Question 24

Possible causes of leukocoria (4)

Answer 24

• Retinoblastoma
• Toxocariasis
• Coat’s disease
• Congenital cataracts

Question 25

Congenital nasolacrimal ductobstruction

Answer 25

Persistent tearing, crusting of eyelashes

Question 26

Clinical sign: wet looking eyes, reflex of mucopurulent material from punctum when pressure is applied over lacrimal sac

Answer 26

Indicates congenital nasolacrimal duct obstruction, different from conjunctivitis in that conjunctiva is not injected

Question 27

How do differentiate between congenital nasolacrimal duct obstruction with congenital glaucoma which also causes tearing?

Answer 27

Enlarged globe and corneal diameter >12mm is indicative of glaucoma

Question 28

Congenital nasolacrimal duct obstruction treatment (3)

Answer 28

• digital massage 2-4x a day over duct
• moxifloxacin drops or erythromycin ointment
• physical opening of tube

Question 29

Amblyopia

Answer 29

An eye that does not see well due to abnormal visual development, develops during first decade of life and does not worsen later on

Question 30

Clinical sign: poorer vision in an eye that cannot be improved with glasses

Answer 30

Amblyopia

Question 31

Amblyopia origin (3)

Answer 31

• idiopathic (most common)
• anisometropia (major diff in refractive error between eyes, eye with worse refractive error sends blurred image to retina and visual pathways and visual cortex is not stimulated)
• strabismus (misalignment of eyes either esotropic or exotropic or hyper hypo tropic, if it is intermittent and alternates between two eyes, good vision can still develop but if constant in one eye amblyopia will likely occur

Question 32

How strabismus can lead to amblyopia

Answer 32

When eyes are misaligned, 2 diff images sent to brain resulting in diplopia, during visual development brain shuts down to deviated eye to avoid diplopia, as reesult visual cortex is not stimulated properly causing poorer vision results in the nonfixating eye

Question 33

How amblyopia can lead to strabismus

Answer 33

Good vision is an essential stimulus to keeping eyes straight, if one is amblyopic, stimulus is lost and eyes can become misaligned, disuse exotropia being most common mech of this

Question 34

Adult who has good vision that then becomes double vision is likely due to…

Answer 34

…cranial nerve palsy

Question 35

Cells in flare/cilliary flush is indicative of…

Answer 35

….iritis

Question 36

High risk group for corneal ulceration

Answer 36

Contact lens wearers

Question 37

Common cause of dendritic keratitis is ____, could also be herpes opthalmacus which presents with ____

Answer 37

Herpes simplex I viral infection often from contact lens use, associated vesicles near the eye

Question 38

Epischleritis shows up only in ____ ulcerative colitis or IBS while iritis can show up in ______

Answer 38

active, active or not