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Ophtho Flashcards

1
Q

Dacryocystitis

A

Infection of lacrimal sac

Usually in infants and adults > 40 yo

Sudden onset pain and redness in medial canthal region.

Sometimes have purulent d/c from punctum

Staph aureus and b-hemolytic Strep usual organisms

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2
Q

Episcleritis

A

infection of episcleral tissue b/n conj and sclera

Mild-moderate discomfort, photophobia, watery discharge

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3
Q

Hordeolum

A

abscess over upper or lower eyelid
- of ciliary follicle and glands along lid margin

usually due to staph aureus

red, tender swelling

Tx:

  • warm compress
  • topical abx
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4
Q

Chalazion

A

Lid discomfort

chronic granulomatous inflmmation of meibomian gland

Hard, painless lid nodule

Tx:

  • usually regress spontaneously
  • may require excision
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5
Q

Orbital cellulitus

A

Infection posterior to orbital septum

Unilateral

Kids more

Fever, proptosis, restriction of EOM, swollen and red eyelids

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6
Q

Allergic conjunctivitis

A

Acute hypersensitivity caused by environmental allergens

PMH of atopic dermatitis, asthma, eta, usually

Sx: intense itching, hyperemia, tearing, conj edema, eyelid edema

Tx: topical antihistamines, artificial tears, cool compresses

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7
Q

Atopic keratoconjunctivitis

A

Severe form of ocular allergy

Itching, tearing, thick mucous discharge, photophobia, blurred vision

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8
Q

Painful retinitis / retinal necrosis + keratitis + conjunctivitis + rapid visual loss

A

HSV retinitis

Fundoscopy - widespread, pale, peripheral lesions and central necrosis of the retina

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9
Q

Painless retinitis

A

CMV retinitis

Fundoscopy - fluffy/granular retinal lesions near retinal vessels + associated hemorrhages

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10
Q

Endophthalmitis

A

1 form is postoperative - usually within 6 weeks of surgery

Change in vision is common

Candida can also cause

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11
Q

Amaurosis fugax

A

Warning that there is a stroke coming!

Can be other etiologies like retinal detachment, optic neuritis

Usually caused by retinal emboli from ipsilateral carotid artery

Transient monocular blindness lasting only a few minutes - “curtain falling down”

Whitened, edematous retina following distribution of retinal arterioles

Vascular in origin usually

Usually in people w/ atherosclerosis, CAD or HTN

Do a duplex US of neck

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12
Q

Central retinal artery occlusions

  • sx
  • cause
  • what it looks like
A

Sx: Sudden painless loss of vision in 1 eye

Cause:
atheromatous particles
emboli
local retinal A compression

Result:
Usually irreversible vision loss

Pallor of optic disc (ischemic retinal whitening)

cherry red fovea

boxcar segmentation of blood in retinal arteries and veins

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13
Q

Central retinal vein occlusion

  • sx
  • causes
A

Sx: Sudden painless unilateral loss of vision

Cause: Usually in HTN pts

Result:
Visual loss variable (vs irreversible in CRAO)

Disk swelling

venous dilation + tortuosity

streaky linear retinal hemorrhages

cotton wool spots

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15
Q

Best diagnostic for acute glaucoma

A

Tonometry

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16
Q

Tx central retinal artery occlusions

A

Ophthalmologic emergency

Ocular massage –> dislodges embolus to help perfuse

Can use anterior chamber paracentesis to lower IOP

Carbogen therapy (5% CO2, 95% O2)

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17
Q

Dx corneal abrasions or herpes keratitis

A

Fluorescein stain of eye

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18
Q

Macular degeneration

A

Early findings - distortion of straight lines such as they appear wavy

Driving and reading one of first activities affected

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19
Q

Episcleritis

A

Inflammation of tissue b/n conj and sclera

Strongly assoc w/ rheumatoid arthritis and IBD

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20
Q

Cause of blindness via Giant Cell Arteritis

A

Ischemic optic neuropathy because involve ophthalmic artery

Will cause permanent blindness

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21
Q

Anterior uveitis

A

Red eye w/ leukocytes in anterior chamber

Inflammation of ciliary body and iris

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22
Q

Uveitis associations

A

Sarcoidosis

Ankylosing spondylitis

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23
Q

External hordeolum

A

THis is a stye!

Common staph abscess of eyelid

Tx w/ warm compresses

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24
Q

Sympathetic ophthalmia

A

Spared eye injury

Immune-mediated inflammation of 1 eye after penetrating injury to the other eye

  • due to uncovering of hidden antigens
  • break open eye, expose immune sys to these antigens in immune-privileged cite

Usually p/w anterior uveitis

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25
Q

Acute angle closure glaucoma - characteristics- consequences

A

Severe painvision losshalos around lightspupils dilatedInjected appearing scleraTearing, N/VPermanent vision loss 2-5 hrs after onset

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26
Optic neuritis
Painful loss of vision Central visual field defect Fundoscopy normal
27
Tx diabetic retinopathy
Laser photocoagulation
28
Tonometry
Measures IOP
29
Tx OA glaucoma
Beta blocker Alpha agonist Carbonic anhydrase inhibitor Prostaglandin analog
30
Tx AAC glaucoma
Pilocarpine drops IV acetazolamide Oral glycerin
31
Tx AAC glaucoma
Pilocarpine drops IV acetazolamide Oral glycerin
32
Pale optic nerve a sign of
Prior infarction (ischemic optic neuropathy) Prior inflammation (MS, optic neuritis)
33
Ddx retinitis pigmentosa
``` Abetalipoproteinemia Mt disease Bardet-Biedl syndrome Laurence Moon syndrome Freidreich ataxia Refsum disease ```
34
Retinitis pigmentosa - mutation - what happens
Chr 3 mutation Degeneration of retinal receptors + adjacent pigment cells Degeneration progresses: small accumulations of pigment appear around periphery of retina Optic disc palor later evident in disease
35
Retinal phakomas
Gliomatous tumors No tx needed Principal components need for makign diagnosis of tuberous sclerosis
36
Red glass test
Get 2 images if eyes not moving together Red image appears to L indicating eye covered by red glass not moving to left as much as other eye REMEMBER: - assume that eye is not moving where red image appears to be
37
Congenital cataracts infections
Rubella | CMV
38
Ddx leukocoria in infant
Can be opacification of lens (cataract) or retina is white Cataract: - rubella - CMV Retina: - scar from retinopathy of prematurity - retinoblastoma
39
Glaucoma can develop in 1/3 of children with what disease?
Sturge weber
40
B12 deficiency scotoma
Blind spot enlarges and extends temporally to involve macula Similar to blind spot w/EtOH and tobacco excess = tobacco-alcohol amblyopia (B1 deficiency)
41
Acute large central scotoma | - ddx?
Methyl alcohol intoxication
42
Papillitis vs/ papilledema
Papillitis (inflamm optic N head) - visual loss - pain w/ eye mvmts - sensitivity to light - pressure on globe - early sign of MS usually Papilledema: - no visual loss
43
Tunnel vision vs. Concentric constriction
Concentric constriction - area perceived enlarges as test screen moved farther away from patient - overall visual field always smaller than normal vis field - if assoc w/ optic atrophy, can happen from neurosyphilis Tunnel vision - same size field even if test screen moved farther away - not physiologic pattern of visual loss - should suggest conversion d/o or malingering
44
Marcus Gunn (afferent pupillary) defect
Dx w/ swinging flashlight test Often in ppl w/ MS as sequela of optic neuritis Damage to optic N --> reduce light perception in affected eye Pupil constrict bilaterally if shine in unaffected eye Pupil dilate if shone in affected eye
45
Nyctalopia
Night blindness Happens w/ retinitis pigmentosa vit A deficiency color blindness
46
Scintillating scotomas
classic for migraine aura
47
Long standing HTN --> retina changes?
Segmental narrowing of arterioles | - can get nicking as arterioles cross over veins
48
Most common eye muscle nerve palsy
6th nerve (abducens) > 3rd N > 4th N
49
Causes of abducens dysfunction w/ LR palsy in: - kid - adult
Kid - increased ICP - direct damage to brainstem (brainstem glioma) Adults: - nasopharynx mets to N - vascular disease
50
Gradenigo syndrome
Facial sensation + LR palsy Happens w/ osteomyelitis of petrous pyramid Abducens and trigeminal N affected as pass close to tip of petrous bone Chronic ear infections can extend to petrous and produce syndrome
51
#1 eye muscle N damaged w/ trauma to face
4th cranial nerve = trochlear SO muscle extends far anterior into orbit --> high risk of injury w/ trauma to orbit or full face Get head tilt w/ injured muscle
52
Most common eye muscle N involved w/ herpes zoster ophthalmicus
4th nerve | - it shares nerve sheath w/ ophthalmic division of trigeminal
53
What type of CN 3 palsy do you get w/ diabetics?
Vessel affected is usually deep in 3rd nerve - not superficial so pupillary constriction usually ok Can get pain in and about eye w/ damaged 3rd N
54
Oculomotor fiber aberrant regeneration - what should you suspect?
Usually due to lesions that chronically compress 3rd nerve Suspect: Aneurysms Cholesteatomas Neoplasms
55
Internuclear ophthalmoplegia
MLF syndrome On attempted conjugate lateral gaze AWAY from side of lesion, get nystagmus - nystagmus (Fast component) is directed temporally to lesion side
56
1 1/2 syndrome
L MLF and L abducens nucleus damaged ``` Left gaze, both eyes still in center Right gaze (away from lesion), get nystagmus to L ```
57
Ocular bobbing
Rapid down deviation of both eyes followed by SLOW upward conjugate eye mvmts Involuntary mvmt usually develops w/ pontine damage (eg pontine glioma) Damage to cerebellum also gets this
58
Optokinetic nystagmus
Should be elicitable in normal pts If nystagmus is less obvious on rotating drum in given direction, pt may have PARIETAL lesion responsible for asymm. response
59
Does orbital cellulitis cause vision loss?
NO! Not usually Will c/o orbital pain, proptosis, pain with eye mvmts CT to see extent of cellulitis
60
Cavernous sinus thrombosis
Proptosis Pain Retina changes VA affected b/c venous drainage not ok
61
Adie tonic pupil
Tonically dilated pupil Usually seen in healthy young women Can occur alone or w/ absent tendon reflexes If unilateral --> suspect local trauma to eye If bilateral --> suspect drug use Probably due to degen of ciliary ganglia Usually benign phenoenon
62
Usher syndrome
Hearing loss + visual impairment Retinitis pigmentosa Defective inner ear
63
Most common cause of acute monocular blindness
Ischemic optic neuropathy - usually due to occlusion of posterior ciliary A (branch of ophthalmic artery) - not assoc w/ carotid disease Sudden painless loss of vision in 1 eye VF have inferior altitudinal defect w/ involvement of central vision --> loss of acuity - opposite eye can get affected soon after RIsk factors: HTN DM Need to exclude GCA
64
How can you tell when you have increased ICP on funduscopy?
Veins normally pulsate Will not pulsate with increased ICP
65
What is best sensory test for afferent pupillary defect?
Swinging flashlight
66
What can give you blurry vision?
``` Papillitis Diplopia Cataracts Papilledema/Optic nerve stuff Macular degeneration Homonymous hemianopia ```
67
For person w/ Horner's, do you see a bigger difference in pupil reflex in dark or light?
Dark
68
How do you monitor retina during electonystagmography studies?
Retina is negatively charged in comparison with cornea -- creates a dipole to monitor
69
Painful Horner's after vigorous activity?
Carotid dissection
70
PIgmentary degeneration of retina
can occur with infections (congenital toxo, CMV) Part of hereditary metabolic disorder (RP)
71
opsoclonus
irregular jerking of eyes in all directions
72
Sudden loss of vision Onset of floaters Fundus is difficult to visualize
Vitreous hemorrhage #1 cause of vitreous hemorrhage is diabetic retinopathy
73
Afferent pupillary defect is very specific for...
Optic nerve problem
74
What aneurysm gives you CN 3 palsy?
Posterior communicating cerebral artery
75
Most common cause of 4th nerve palsy
Head trauma
76
#1 cause of cherry red spot of fovea?
Central retinal artery occlusion There is ischemia of retina - becomes pale - and now can see choroid clearly underneath macula
77
Circulation of eye
Chroidal circulation Retinal arteries
78
Most common cause of viral conjunctivitis is
Adenovirus. Infection often has systemic sx
79
Ocular migraine sx
Binocular!
80
``` A 3-year-old female is brought to your office for a health maintenance examination, and her father expresses concern about her vision. Her visual acuity is 20/20 bilaterally on a tumbling E visual acuity chart. With both eyes uncovered during a cover/uncover test, the corneal light reflex in the right eye is medial to the pupil when focused on a fixed point, but the light reflex in the left eye is almost centered in the pupil. When the left eye is covered, the right eye moves quickly inward to focus on the fixed point, and the corneal light reflex is centered in the pupil. When the left eye is uncovered, the right eye returns to its original position. When you cover the right eye, no left eye movement is noted. Which one of the following is the most likely diagnosis? (check one) A. Strabismus B. Amblyopia C. Cataract D. Esotropia E. Heterophoria ```
Strabismus is an ocular misalignment that can be diagnosed on a cover/uncover test when the corneal light reflex is deviated from its normal position slightly nasal to mid-pupil. The misaligned eye then moves to fixate on a held object when the opposite eye is covered. The eye drifts back to its original position when the opposite eye is uncovered. Amblyopia is cortical visual impairment from abnormal eye development-most often as a result of strabismus. Cataract is a less frequent cause of amblyopia. Esotropia is a type of strabismus with an inward or nasal deviation of the eye that would be evidenced by a corneal light reflex lateral to its normal position. (The outward eye deviation seen in this patient is exotropia.) Heterophoria, or latent strabismus, does not cause eye deviation when both eyes are uncovered.
81
Age related macular degneration - predisposition - risk factors
occurs more frequently in light-skinned individuals than in dark-skinned individuals. Risk factors include smoking and hypertension
82
Ophthalmopathy of Grave's may get worse when treated w/ what?
Radioactive iodine
83
Ophtho side effect of sildenafil
Non-arteritic anterior ischemic optic neuropathy (NAION) is a very rare but serious condition which may occur in men taking sildenafil. It causes restriction of blood flow to the optic nerve and can result in permanent blindness.
84
Bitot spots
Dry silver-gray plaques on bulbar conj Seen in vit A deficiency
85
Tx bacterial conjunctivitis
Sulfonamide drops
86
Binocular fixation present at what age in kids?
3-4 months
87
NOrmal acuity in newborn is...
20/200 - 20/400
88
Coloboma
Defect of lid that can range from small indentation to large cleft Can lead to ulceration from excessive drying
89
Epicanthal folds
Folds of skins on nasal side of eye Usually more prominent at birth and recede with time Responsible for pseudostrabismsus by making eyes appear closer together
90
Blepharitis
Inflammation of lid margins
91
Most common causes of neonatal conjunctivits
Chlamydia | Gonorrhea
92
Conjunctivitis
Tearing COnjunctival injection Lid edema Discharge
93
Dacryostenosis
Caused by congenital lacrimal duct obstruction Usually unilateral CLear d/c Spontaneous resolution by age 1
94
Strabismus
Misalignment of eyes Deviations can be: - convergent (esotropia) - divergent (exotropia) - results from abnormal innervatino of muscles from supranuclear nerve
95
Dx strabismus
Hirschberg test - looking for corneal reflex Cover test
96
Amblyopia
decrease in acuity 2/2 unclear image falling on retina Usually 2/2 strabismus or by opacity in visual axis
97
Dx corneal abrasions
Slit lamp of eye under blue filtered light after instillation of fluorescein Tx - topical abx
98
Periorbital cellulitis
No true orbital involvement ONly eyelids and surrounding tissues involved Eye mvmts normal
99
Follicles + inflammatory changes in conjunctiva of eye Neovascularization in cornea Immigrant
Trachoma 2/2 C. trachomatis serotype A-C Can also cause nasal discharge as it moves Tx: Topical tetracycline or oral azithromycin

Neuro (3 decks)

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