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IPAP > Ophthalmology: Review Slides > Flashcards

Ophthalmology: Review Slides Flashcards

1
Q

What are the eight components to a basic eye exam?

A 
Confrontational visual fields
Ophthalmoscopy
Ocular motility
Pressure, intraocular
Pupil reaction
Anterior chamber depth
Acuity
Ancillary- Color Amsler Upper lid eversion
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2
Q

Eyelids are AKA ?

What are the two function

A

Palpebrae

Protection
Aid lacrimal system- spread new, pump old

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3
Q

What glands are contained w/in the eye lids and what do they make?

What is the space between the upper/lower lid called

What is the name of the union between the upper and lower lids?

A

Meibomian- oil part of tears

Palpebral fissure

Canthus

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4
Q

What are the three eyelid muscles, their function, and what are they innervated by ?

A

Orbicularis oculi- closes, CN7

Levator palpebrae superioris- opens upper, CN3

Mueller’s Muscle- assists opening lids; Symp ANS

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5
Q

Define LR6SO4REST3 movement and CN innervation

A

SR: elevation, 3
LR: abduct, 6
IR: depression, 3
MR: adduction, 3

IO: extortion/elevation, 3
SO: intorsion/depression, 4

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6
Q

Eye muscles work in ?

What type of response has to occur for movement to occur?

A

Tandem, yoked

Ipsilateral opposing muscle relaxation

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7
Q

Define Emmetropia

Define Myopia

A

Normal vision

Nearsighted, axial length too long, image falls in front of retina

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8
Q

Define Hyperopia

Define Astigmatism

A

Farsighted, axial length too short so image falls behind retina

Elliptical shape, refracting power is different between cornea and lens

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9
Q

Define Strabismus

Define Phoria

Define Tropia

A

Misalignment of eye

Deviation only apparent when eye is covered

Deviation is evident w/ both eyes open

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10
Q

What are the four prefixes for eye deviations

A

Eso: in
Exo: out
Hyper: up
Hypo: down

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11
Q

Dec red reflex indicates?

Strabismus is revealed w/ ? test

A

Eye pointing in wrong direction
Poor in amblyopia

Cover/uncover or Hirschberg

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12
Q

Acquired strabismus’ can cause ? and associated w/ ? underlying issue

If congenital (<6mon), what is the PT at risk for developing?

A

Diplopia, primary or off-axis
CN palsy, mass

Amblyopia

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13
Q

What type of strabismus is present w/ CN3, CN4 or CN6 palsy?

Define Nystagmus

A

3: R norm, S down, left; aneurysm
4: both to R; congenital trauma
6: R normal, L to R; cranial pressure

Repetitive/rhythmic oscillations of eyes

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14
Q

What are the different types of nystagmus?

Most congential nystagmus’ are ? and require ?

A

Physiologic: normally evoked
Pathologic: congenital, acquired
Jerk: slow drift w/ fast recovery
Pendular: equal paced drift/recovery

Idiopathic
Complete exam

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15
Q

Define Neuro-Significant Nystagmus

Define Amblyopia

A

Vertical/see-saw motions due to brain stem lesion

Abnormal development of visual system w/out anatomical damage

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16
Q

Amblyopia is AKA ? and results in ?

What are the 3 etiologies

A

Lazy eye, not necessarily misaligment
Bi/Lateral reduced vision

Refractive
Strabismus
Occlusion

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17
Q

How are amblyopias Tx?

When is the visual potential the greatest?

A

Glasses
Patch/atropine
Surgery

<8y/o, neuroplasticity

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18
Q

What are the 3 layers of tears and where are they made?

A

Outer: oil, meibomian gland
Mid: water, accessory/lacrimal
In: mucin, goblet

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19
Q

Define Extropion

How does it present

What is it caused by

How is it Tx

A

Outward turning of lower lid

Tearing/irritation

Scarring from skin d/o
Inc lid laxity
CN7 palsy

Lubrication until surg correction

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20
Q

Define Entropion

How does it present

What is it caused by

How is it Tx

A

Inward turning of lower lid

Foreign body sensation Irritation Tearing

Involution from age
Conjuctival scarring

Lube until surgical correction

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21
Q

Define Blepharitis

How does it present

How is it Tx

A

Inflammation of eyelid

Burning Foreign sensation Epiphora worse in AM
Concomitant ocular rosacea

Eyelid scrub/warm compress
Mod/Sev: Erythro ointment (ung) every bedtime (uhs) or,
Doxy 100mg PO QD x 2wks

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22
Q

Define Chalazion

How does it present

How is it Tx

A

Nodule inside of meibomian gland

Mild discomfort

Warm compress/massage
Steroid injection/excision >4wks

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23
Q

Define Hordeolum

How does it present?

How is it Tx

A

Staph infected nodule causing pain

Red/painful nodule

Warm compress/massage
Doxy 100mg BID
Erythromycin 250mg BID
Surgery if recalcitrant
UnTx= preseptal
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24
Q

Define Dacryoadenitis

How does it present

What can cause this?

A

Inflammation/infected lacrimal gland

Unilateral temporal lid tenderness in kids/young adults

Mumps/EBV
Idiopathic
Bacteria

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25
Q

What image is ordered for dacryoadenitis

If condition is bilateral, what DDxs need to be considered?

How is this Tx?

A

Orbital CT

Sarcoid
Sjogrens

Mild: COLD compress, NSAID
Acute/purulent: ABX/Anti-viral
Idiopathic/Resistant: PO steroid, responds <48hrs

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26
Q

Define Dacryocystitis

How does this present

What can cause it?

A

Inflammation of lacrimal sac and/or canaliculus

Tearing, pain w/ erythema, purulent drainage
Preseptal cellulitis

Bacterial infection
Nasolacrimal duct obstruction

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27
Q

How is Dacryocystitis Tx

Define Conjunctiva

A

Warm compress/massage
Amox/Clavu 500mg TID
InD if large abscess
Febrile= admit w/ IV ABX

Thin mucous membrane on inner surface of eye lid and outer surface of eye

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28
Q

What are the two conjunctiva

Define Fornix

A

Palpebral- inner eye lid
Bulbar- over sclera

Point that bulbar/palpebral conjunctiva meet

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29
Q

What is the causes, S/Sxs and Tx for viral conjunctivitis

A

Adenovirus

Watery d/c
Diffuse injection
Pre-auricular adenopathy
Infiltrates

Self limiting but highly contagious

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30
Q

What is the causes, S/Sxs and Tx for allergic conjunctivitis

A

Pollen, mold, pets

Stringy d/c, Itching, Chemosis

Topical antihistamine

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31
Q

What is the causes, S/Sxs and Tx for bacterial conjunctivitis

A

Staph A
Strep pneumo
C trachomatis
N ghonorrea

Mucopurulent d/c

Topical ABX

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32
Q

Define Pinguecula

How does it present

How are they Tx

A

Yellow bumpy growth on conjunctiva at 3/9 o’clock w/out invading cornea

ASx, no vision changes

Artificial tears
Topical steroids if severe

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33
Q

Define Pterygium

How does it present

How is it Tx

A

Yellow bumpy growth on conjunctiva at 3/9 o’clock that invades cornea, irritation and vision loss

Tears/sunglasses
Surgery- interference w/ sight/close to visual axis, excessive irritation

34
Q

Define Thyroid Eye Dz

This is the MC cause of ?

A

Graves Ophthalmopathy or any thyroid state- hyper, hypo, eu

Unilateral proptosis in adults

35
Q

How does early/late thyroid eye dz present

What is done for work up and how is the Dx confirmed?

A

Early:
Burning Photophobia Red Tearing
Late:
Pressure Chemosis Swelling

Complete thyroid tests
If normal- careful monitor
Confirmed w/ CT scan

36
Q

How is Thyroid Eye Dz Tx

A

Mild:
Tears
Elevated head at night/taping

Mod/Sev:
PO Prednisone
Orbital decompression/radiation
Lid retraction repair
Strabismus surgery
37
Q

What is used to stain the eye to assess for corneal abrasion?

What sign may be seen?

A

NaFl (flourescein)

Seidel’s- penetrating trauma

38
Q

How are corneal abrasions Tx

How does bacterial kertitis present?

A

Topical fluroquinolone (prophylactic)
Cycloplegic
No patches/touching/contacts

Infected cornea w/ white opacity and epithelial defect due to colonization of corneal stroma

39
Q

Bacterial keratitis MC occurs after ?

This can also occur from

This condition causes ? to the eye

A

Contact lens wearing

Anterior segment dz

Stromal thinning (ulcer)

40
Q

What are the S/Sxs of bacterial keratitis

What microbes can cause it?

How is it Tx?

A

Pain Edema Photophobia
Hyperemia

Staph Strep Serratia
Pseudomonas Moraxella

Fluoroquinolone and Cycloplegic drops w/ daily f/us
Wears contacts- add Polymyxin B/Trimeth or Tobramycin

41
Q

Pseudomonas keratitis is especially high risk in ? PTs

Fungal Keratitis will present w/ and is due to ?

A

Contact wearers
Can perf cornea <48hrs

Asymmetric feathery edges after trauma w/ vegetative matter

42
Q

What is the inner and outer layer of the sclera?

What is it made of?

Where is the thickest point?

A

In: stroma
Out: episclera

Collagen
Elastic fibers

Posterior aspect

43
Q

Two functions of sclera?

Episclera is made of ?

Episclera is joined to ? by CT strands

A

Protection
Attachment point for EOMs

Vascularized CT

Tenon’s Capsule- CT that encases globe as sleeve like sheath that covers tendons at EOM insertions

44
Q

Episcleritis

What associated d/os can cause this

A

MC idiopathic
More prevalent in younger PTs

Herpes Thyroid dz
Collagen vascular dz (RA, Lupus)
Rosacea

45
Q

How does Episcleritis present

What tests are done during work up?

How is it Tx

A

Acute w/ mild pain
Normal acuity
Engorged vessels w/out d/c

Slit lamp w/ anesthesia (phenylephrine) cause blanching

Mild: Cold compress/tears
Mod/Sev: topical Fluorometholone or Loteprednol
Ibuprofen

46
Q

Scleritis

What tests are done to differentiate from episcleritis

A

Severe boring pain across jaw/forehead
Inflammation
Photophobia

Phenylephrine does not blanch
Slit lamp green light- avascular indicates necrosis

47
Q

How is scleritis Tx

Necrotizing scleritis is Tx the same way but w/ ? referral?

A

NSAIDs
H2 blocker
Prednisone
ImmSuppressor- Clophosphamide

Rheumatology

48
Q

How is posterior scleritis tx?

A

Cyclophosphamide
Rituximab
Glucocorticoids

49
Q

Major differentiator for scleritis

Major differentiator for conjunctivitis

A

Severe pain

D/c

50
Q

What are the 3 parts of the uveal tract and their funtion?

A

Iris- only visible portion

Ciliary body- produces aqueous humor; contains ciliary muscle for accommodation

Choroid- between sclera and retina; supplies blood to retina

51
Q

Anterior uveitis may be AKA ?

This is associated w/ ? d/os?

A

Iritis
Iridocyclitis

\+HLA-B27- Anklyosing, Reiters
Sarcoidosis
Syphilis/TB
Lymphoma
Trauma
52
Q

How does anterior uveitis present?

How is this Tx

A

Ciliary flush
Keratic precipitates:
fine/white= non-granulas
Mutton fat= granulomatus

Mild/Mod: scopolamine
Sev: Atropine
Prednisolone

53
Q

What is the prognosis for anterior uveitis?

Posterior uveitis is AKA ?

A

First- excellent
Repeat- poor

Vitreitis
Choroiditis
Retinitis

54
Q

What d/os are associated w/ posterior uveitis?

How does this present?

A

Toxoplasmosis- MC
AIDS- CMV
TB/Syphilis

Dec vision w/ floaters
Hazy vitreous
Optic disc swelling

55
Q

How is posterior uveitits Tx

What is the MC severe infection of the eye?

What happens if this MC is left unTx?

A

Topical cycloplegic/steroid

CMV when CD4 <100

Blind <6mon

56
Q

CMV retinitis is seen in ? PT populations?

How does this present in clinic?

A

AIDs
Transplant
Lymphoma
Leukemia

Floaters
Blurred vision
Blind spots- scotomata
Flashes if retinal detachment

57
Q

What two Sxs are rare w/ CMV retinitis?

What is the most common sign finding?

A

Pain
Photophobia

Cotton wool spots

58
Q

MC Sx of late onset strabismus from stroke/trauma/tumor?

Lateral lid pain, swelling, tenderness is ? Dx

A

Diplopia

Dacryoadenitis

59
Q

Contact wearer w/ red/painful eye. Upon fluorescein exam, green burst is seen meaning ? Dx

What part of the body has the highest protein concentration of any body tissue?

A

HSV keratitis

Lens

60
Q

What are the 3 parts of the lens?

MC RF for cataracts?

A

Capsule Cortex Nucleus

Age

61
Q

Define Nuclear Cataract

Define Posterior Subcapsular Cataract and it’s MC Sxs

A

Yellow/brown discoloration of central view
Distance vision more blurry than near

Opacities near posterior aspect of lens
MC Sxs- glare, difficulty reading

62
Q

Define Cortical Cataracts and their presentation

What issues develop as cataracts develop?

What is one benefit of developing nuclear cataracts?

A

Radial/spoke like opacities
ASx until central field invaded

Glare w/ headlights- common
Monocular diplopia
Foxed spots in visual fields
Dec color perception
Progressive visual loss

Thickening lens= second sight, improved near vision
Near vision dec w/ posterior subcapsular cataracts

63
Q

How are cataracts Tx by stage of development

What are 3 reasons to perform cataract surgery

A

Early: spectacle prescription
Small central: pupil dilation
Late: removal; corrective refractive error

Manage Dzs (glaucoma diabetes)
Improve visual function
Prevent deprivational amblyopia in infants
64
Q

MC cause of congenital cataracts

What are the 3 types of congenital cataracts

A

Idiopathic

Polar: opacity of lens pole
Nuclear: opacity of fetal nucleus
Lenticonus: opacified protrusion of lens capsule

65
Q

What are the S/Sxs of congenital cataracts

This condition worked up focusing on?

How is it Tx

A

Mild-Sev decreased vision
Infant squints/keeps eyes closed
Absent/decreased red reflex

Hx of maternal illness

Medical emergency, surgical Tx in first 3-4mon

66
Q

Why do congenital cataracts in infants have to be tx so quickly?

Define subluxation lens anomaly

A

Prevent amblyopia

Partial disruption of the zonular fibers
Decentered lens but partiall in aperture

67
Q

Define dislocated lens abnormality

What is the MC and other associated RFs for lens position anomalys

A

Complete disruption of the zolular fibers
Lens is displaced out of posterior chamber

MC- trauma
Marfans- superotemporal
Homocystinuria- inferonasal
Acquired syphilis
High myopia
68
Q

How do lens position anomalys present

Define Floaters

A 
Dec vision w/ monocular diplopia
Iridodenses
Phacodonesis
Irregular astigmatism
Angle closure glaucoma

Small aggregates of vitreous from normal aging

69
Q

What is the causes of acute onset floaters?

Define Flashers

A

Posterior vitreous detachment
Retinal tear
Uveitis
DM/Sickle associated bleeding

Suggests vitreal traction on peripheral retina
from posterior vitreous detachment/retinal tear

70
Q

What does flashers w/ floaters indicate?

If flashes occur w/ migraines what may be seen?

A

Blood/pigment in vitreous

Scintillations
Zig-zag lights

71
Q

What are the RFs for vitreous detachments

How does this present

How is it Tx

A

Diabetic retinopathy
Ophthalmic surgery
Trauma

Sudden appearance of black spots/flashing lights

Refer
Photocoagulation/cryotherapy for retinal detachment

72
Q

When viewing PTs retina, where is the optic disc?

What supplies blood to the different areas of the retina?

A

Nasal portion

Inner retina- central retinal artery
Outter retina- choroid

73
Q

What do retinal arteries and veins look differently on exam?

How are peripheral retinal structures viewed

A

Art: orange/red
Vein: larger, crimson

Indirect ophthalmoscopic techniques

74
Q

What provides retinal pigment epithelium?

What are the RFs for retinal artery occlusion

A

Metabolic support system

GCA
Embolus
Thrombosis
Collage vascular dz
Hypercoagulation d/o
75
Q

What are the S/Sxs of a retinal artery occlusion

What will be seen on exam?

What is the only vascular structure spared?

A

Unilateral painless acute vision loss

Whitening of retina
Cherry red macula
Box car segmentation arterioles

Cilioretinal artery

76
Q

What type of retinal occlusion occurs if clot comes from central retinal artery?

What type of occlusion occurs if clot comes from branch of retinal artery and what type of loss will be seen

A

CRAO

BRAO
Horizontal hemifield vision loss

77
Q

What structure of the eye may be spared during a retinal artery occlusion?

What is the first lab ordered when PT presents w/ suspected retinal artery occlusion?

A

Macula due to choidal supply

ESR, r/o GCA

78
Q

How is retinal artery occlusion Tx

What will be seen on exam during retinal vein occlusion?

A

Occular massage
Anterior chamber paracentesis
Acetaolamide
Timolol topicals

Blood and Thunder fundus
Dilated veins
Flame shaped hemorrhage
Cotton wool spots/exudates

79
Q

If BRVO is present, what part of vision is lsot?

What are the two types of retinal vein occlusions and what will be seen?

A

Horizontal hemifield loss w/ respect to horizontal line

Ischemic CRVO- multiple cotton wool spots w/ extensive hemorrhage
Non-ischemic CRVO- mild fundus changes

80
Q

How is retinal vein occlusion Tx

What is the leading cause of blindness in the US for ages 20-64?

A

Mandatory ophthalmic eval <72hrs
D/c OCPs
PRP neorevascularization (iris/angle)
ASA 325 once a day

DM

81
Q

After DM Dx, optical baseline needs to be established w/in ?

What type of DM rarely has retinopathy?

A

6mon

DMT-1 but will develop proliferative dz after 30yrs

82
Q

What hormones can influence acceleration of diabetic retinopathy?

What are the 4 levels of severity for non-proliferative diabetic retinopathy?

A

Puberty
Pregnancy

VMild- microaneurysms
Mild- microaneurysm, exudate, wool spots
Mod: severe retinal hemorrhage, mild IRMA
Sev: 4-2-1
4 quads severe retinal hemorrhage
2 quads venous beading
1 quad IRMA

IPAP (212 decks)

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