Ophthamology Flashcards
Blepharitis: what, tx
Dacrocystitis: what, location, TX (3)
Dacryoadenitis: what, location, cause categories, TX (3)
Blepharitis: chronic staph infection of eyelid margin; baby shampoo, topical antibiotics
Dacrocystitis: Lacrimal sac infection, inferior medial, topical/systemic abx, decongestant, warm compress
Dacryoadenitis: lacrimal land infection, superior/lateral
categories: infectious, connective tissue (sarcoidosis/Sjogren’s), neoplastic
warm soaks, abx, I&D
Pictured entity: what,, tender?, Location, treatment (2)
Chalazion: –Chronic Internal sterile granulomatous reaction of meibomian gland
nontender, mid (often) upper lid off and away from margin
warm compresses, antibiotics
Pictured entity, what, treatment (2)
lid lacerations to refer (5) - review
Hordeolum/Stye; lid margin staph abscess, warm compresses, abx ointment
–Lid margins
–Canalicular system (suspect when medial eyelid involved)
–Levator or canthal tendons
–Orbital septum (orbital fat will protrude – eyelids have no subcutaneous fat)
–Significant tissue loss
Perirbital/orbital cellulitis
common method of acquisition age < 2
most common source of orbital cellulitis
consider this test due to complication
tx
Hematogenous
ethmoid sinusitis
lumbar puncture
cefuroxime
Complications
- Meningitis - most common
- Septicemia
- Orbital and subperiosteal abscesses
- Cavernous sinus thrombosis - Cranial nerve 3 - 6 deficits
- Vision loss - increased IOP, decreased blood flow to retina
Pneumonic for EOM cranial nerves
lid movement control
pictured entity
SO4 (down when medial, IR), LR6 (lateral), Everything else 3
CN7 - closes, CN3 AND sympathetically innervated Mueller muscle
this is why disruption of sympathetic chain (eg Horner’s) in addition to third nerve palsy can cause ptosis
Horner’s syndrome
Argyll Robertson pupil - what
Marcus Gunn pupil - what
Pupillary control (2)
pictured entity
AR: Small irregular pupil with further constriction with close gaze but does not react to light
caused by neurosyphilis
MG: = afferent pupillary defect; affected does not sense light so swinging flashlight from unaffected side causes apparent paradoxical dilatation
caused by disease blocking light in globe (hemorrhage) or anywhere along afferent pathway
control: parasympathetics in 3 constrict, sympathetic dilates
picture: sixth cranial nerve palsy
Horner’s syndrome (3)
associated pathway
associated disease categories (2)
pictured disease
Ptosis, miosis, anhydrosis
caused by disruption of the sympathetic chain which leaves thorax and travels with internal carotid
diseases:
–Carotid disease (dissection, trauma, aneurysm)
–Tumor (neck, lung apex)
third cranial nerve palsy
Visual field deficits - review
bitemporal hemianopsia
homonymous hemianopsia
bitemporal hemianopsia - optic chiasm (pituitary tumor, aneurysm)
homonymous hemianopsia - optic tract
Central retinal artery occlusion
appearance of retina
associated conditions (2)
treatment review (5)
pale with cherry-red spot in macula due to different blood supply
temporal arteritis, sickle cell
tx: globe massage, hypercapnia, ocular beta-blocker, acetazolamide, ocular paracentesis
Pictured entity retinal appearance (2)
tx
Cotton wool spots, blood and thunder
no treatment
slower onset compared to CRAO
dx: eye pain, APD, loss of color vision
closely associated condition
retinal detachment
risk factors review (6)
ideal positioning
Optic neuritis
MS
diabetes, sickle cell, family history, previous history, advanced age, nearsighted
superior - lay flat, inferior elevate head
Temporal arteritis AKA
dx criteria
may present as
in 50% includes
AKA giant cell arteritis
Age greater than 50, temporal artery tenderness or decreased pulse, headache, ESR > 50 biopsy positive
may present as amaurosis fugax
in 50% includes impaired vision
EKC =?
Cornea appearance (2) treatment
epidemic keratoconjunctivitis = bad conjuntivitis with impaired visual acuity
ecchymosis with stippling
steroid eyedrops
Bacterial conjunctivitis
common agents (5)
neonatal agents
workup
Staph, strep, H Flu, GC, Pseudomonas in contact lens
neonatal: chemical in first 48 hours, chlamydia, GC, strep/staph
Gram stain and culture always
chlamydia: conjunctivitis, otitis, pneumonia
Uveitis iritis
inflammation of?
Cause categories (3)
treatment (3)
Iris, ciliary body, choroid
infectious, traumatic, rheumatic
+/- antibiotics, steroids, mydriatic (dilate pupil)
Pictured entity
Cause categories (4) classic physical finding
complication
keratitis (UV in this case): Inflammation of the cornea
infectious, chemical/exposure (like UV keratitis), Sjogren’s, drug toxicity
Perilimbic flush = circumferential redness of the sclera at the edge of the cornea
corneal ulcer-assume bacterial
Pictured entity
age groups include
treatment (2), contraindicated
related condition and eponym
salient differences (2) treatment difference
HSV keratitis
neonatal
acyclovir, cycloplegic
avoid steroids
herpes zoster ophalmicus
lid lesions common, pseudo-dendritic pattern (no staining)
steroids often utilized
Corneal ulcer - most common cause, contact lens wearer
picture suggestive of
Cause-Pseudomonas
picture suggestive of - foreign body under the lid (ice rink sign)
Pictures suggestive of
treatment medications (4) diagnosis
Globe rupture
IV antibiotics, analgesics, antiemetics, tetanus
clinical and CT or MRI
Chemical burns
alkali necrosis type, management
acid necrosis type, management
Liquefaction necrosis, prolonged irrigation up to 24 hours due to ongoing burn until completely removed
coagulation necrosis, typically stops due to lack of deep penetration, irrigation
Red, painful eye, “Steamy” hazy cornea, Blurred vision / “halos”, Nausea / headache, Mid-dilated pupil, non-reactive and pictured entity = ?
Triggers for this condition (2)
treatment goals (2) with meds (3-4 + 1)
Acute angle closure glaucoma
dim light, mydriatics
reduce aqueous humor production: topical beta-blocker (timolol), alpha agonist (apraclonidine), IV Acetazolamide or Mannitol
Open angle: miotic (pilocarpine) in both eyes
Hyphema - common etiologies (2)
complications, worst (2) and others
treatment: medication (2)
treatment, supportive (2)
Traumatic, coagulopathy
re-bleeding and glaucoma; also adhesions, corneal blood staining, impaired vision
medications: topical atropine, steroids, eye shields
supportive: elevate head of bed, bilateral eye shields
more severe cases will require surgery
Pictured condition versus optic neuritis
common causes (4)
Vision is preserved in Papilledema
causes: pseudo-tumor cerebri, malignant hypertension, hydrocephalus, elevated ICP from tumor or other cause
Inflammation/infection of the intraocular cavities with pain, injection, hypopyon, edema, visual acuity, chemosis, papillitis, cotton-wool spots, uveitis =
most common cause category = types (2)
treatment (1)
chronic form can occur when
Purulent endopthalmitis
exogenous from Ieyesurgery or trauma; rarely endogenous from septic emboli, 2x frequency on R
antibiotics for gram+ or fungal cause as appropriate;
Chronic form: Propionibacterium acnes = chronic inflammation usually post-cataract surgery - mild symptoms
Pictured entity suggestive of and most common location
decreased sensation of cheek, upper lip suggests
gaze type affected by most common form of entrapment
Medial wall orbital blowout fracture
involvement of infraorbital nerve
upward gaze
Epistaxis in setting of isolated eye trauma suggests
Pictured entity, traumatic mechanism
Retrobulbar hemorrhage - pupil, tx (2)
Suggestive of orbital fracture
Likely medial orbital blowout fracture with entrapment and inhibition of upward gaze
Hemorrhage: dilated, nonreactive; lateral cathotomy, meds to decrease IOP
