Ophthamology

Question 1

What are 4 red flags for orbital (post-septal) cellulitis?

Answer 1

1) Ophthalmoplegia
2) Pain with eye movement
3) Proptosis
4) Decreased visual acuity

Question 2

What do you call the condition with decreased peripheral vision progressing to blurry vision, pale optic discs, and pain with eye movement?

What condition is associated with this?

Tx?

Answer 2

Optic neuritis

Multiple Sclerosis

IV methylprednisolone

Question 3

Dendritic lesions in the cornea via fluorescein imaging is diagnostic for what?

What NOT to give?

Answer 3

Herpes ophthalmicus (zoster OR simplex)

• Zoster = vesicular rash in trigeminal distribution (forehead, nose, eyes)
• Simplex = NO RASH

NO steroids!

Question 4

2 mo child presents for wcc. Ophthalmo exam shows white reflex in the R eye. What must you consider? What is best course of action?

Answer 4

Leukocoria (white reflex) –> considered RETINOBLASTOMA until proven otherwise!!

Must refer to Ophthalmologist!

Question 5

What does asymmetric red reflexes or corneal light reflexes. When the normal eye is covered, the mis-aligned eye shifts to realign. What is this?

Answer 5

Strabismus

Tx: with patching

Question 6

Person has progressively worsening vision in the R eye. When covering the L eye and looking at a grid chart, the vertical lines appear bent and wavy to him. What is going on?

Answer 6

Macular degeneration

Distortion of straight lines (appear wavy) on grid test

Drusen deposits in the macula

Question 7

In person with HIV, what causes progressive bilateral keratitis and conjunctivitis with eye pain. Visual loss rapidly follows. Fundoscopy reveals multiple pale, peripheral retinal lesions w/ central necrosis of the eye. What is it?

Answer 7

HSV retinitis

Question 8

What is sympathetic ophthalmia?

Answer 8

“Spared eye injury” –> after penetrating trauma injury to one eye, the OTHER eye develops immune-related inflammation (uncovering “hidden” antigens)

*Anterior uveitis

Question 9

Agents to give in acute glaucoma?

Answer 9

Mannitol
Acetazolamide
Pilocarpine
Timolol

Question 10

Agent NOT to give in acute glaucoma? Why?

Answer 10

Atropine – causes mydriasis (dilation) of eye and further increases intra-ocular pressure

Question 11

Patient has chronic headaches, a bruit noted in subclavian area, pain when chewing, and now developed sudden onset loss of vision in R eye. What is it? next best step?

Answer 11

Giant cell (Temporal) arteritis

*High dose IV corticosteroids

Question 12

Sudden onset of flashing lights and blurred vision in person’s R eye. Ophthalmo exam shows retinal tears and grayish coloration of retina. What is the cause?

Answer 12

Retinal detachment

*Look for past hx of trauma to eye - including cataract surgery

Question 13

If CN III is affected by diabetes, what is the mechanism an signs?

If CN III is affected by compression, what are the signs?

Answer 13

Diabetes causes ischemic neuropathy of blood vessels to nerves –> somatic and parasymp fibers of CN III have SEPARATE blood supplies –> in diabetes the somatic are only affected
**“Down and out” gaze but accommodation and pupil’s light response remain INTACT

Compression of CN III will affect BOTH somatic and parasymp
**Ptosis, “down and out” gaze, fixed, dilated pupil, no accommodation

Question 14

7 days after cataract surgery in L eye, woman develops decreased visual acuity in L eye. Her eyelid is swollen and has red conjunctiva with exudates in the anterior chamber. What is it?

Answer 14

Post-op endophthalmitis

Question 15

80 yo male has sudden loss of vision in his L eye. Ophthalmic exam shows swelling of optic disk, retinal hemorrhages, dilated and tortuous veins, and cotton wool spots. What is it?

Answer 15

Central retinal vein occlusion

Question 16

Severe eye pain with blurred vision associated with nausea and vomiting. The eye is red and the pupil is dilated and non-reactive to light. What is it?

Answer 16

Acute angle-closure glaucoma

Question 17

What condition causes gradual loss of peripheral vision over several years with eventual tunnel vision and cupping of the optic disc?

Tx?

Answer 17

Open angle glaucoma

Tx: B-blocker (Timolol drops)

Question 18

What part of the vision does macular degeneration affect?

Answer 18

Central vision

Question 19

Sudden onset redness, watery discharge, and itching of both eyes. There is b/l injection with granular appearance of conjunctiva. The lungs have few scattered wheezes present. What is it?

Answer 19

Allergic conjunctivitis

No tx needed - resolves in 24 hrs

Question 20

32 yo woman has decreased visual acuity, sluggish afferent pupillary response to light, and changes in color perception. Fundoscopy reveals a swollen disc. What is the most likely diagnosis?

What is a common association?

Answer 20

Optic neuritis

*Multiple Sclerosis

Question 21

Most common cause of orbital cellulitis?

Answer 21

Bacterial sinusitis

Question 22

3 phases of diabetic retinopathy?

Answer 22

1) Background/simple –> micro aneurysms, hemorrhages
2) Pre-proliferative –> cotton wool spots
3) Proliferative –> neovascularizaiton

Question 23

This drug used for SLE can cause retinopathy and eye damage?

Answer 23

Hydroxychoroquine

Question 24

What causes B/L loss of central vision?

Answer 24

Macular degeneration

Question 25

One-sided sudden loss of vision with reduced light perception in the same eye. Fundoscopic exam shows loss of fundus details and floating debris with a dark red glow?

Answer 25

Vitreous hemorrhage

Question 26

38 yo with AIDS has decreased vision in both eyes. Currently afebrile. Fundoscopic exam shows yellow-white patches of retinal opacification and retinal hemorrhages. What is it?

Answer 26

CMV retinitis

Question 27

Sudden, painless loss of vision in one eye in person with carotid bruit. Exam of the eye shows visual acuity 20/60 and subtle retinal whitening. What is it? What is next best step in mgmt?

Answer 27

*Central retinal artery occlusion –> embolism (vasculitis, carotid artery disease, endocarditis)

Tx: Ocular massage + high flow O2