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Ophtho Flashcards

1
Q

4 borders of the orbit

A

sup: frontal sinus
medial: ethmoid bone (lamina papyracea “paper thin”)
inferior: maxillary sinus
laterally: zygomatic bone

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2
Q

eye exam

A

-adnexa
-acuity
-visual fields
-pupils
-EOM
- inspect globe
-retinal exam with fundoscope
- slit lamp –> ant chamber
- fluorescein
- IOP

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3
Q

test for corneal laceration?

A

Seidel’s sign

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4
Q

normal IOP? contraindication to checking IOP with tonopen?

A

10-20 mm Hg
-suspected globe rupture

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5
Q

to examine cornea, slit lamp should be?

A

bright, thin, 45 degree angle (allows assessment of anterior chamber)

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6
Q

common triggers for preseptal cellulitis?
most common age?
most common bugs?

A

URTI, sinusitis, chalazion, hordeolum, insect bites and trauma. mostly in ppl <10
staph, strep

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7
Q

triggers for orbital cellulitis?

A

-paranasal sinusitis (esp ethmoid)
-trauma, intraorbital fb, postop, spread for preseptal infection

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8
Q

presentation of orbital cellulitis?

A

URI, facial pressure, fever, pain with EOM, photophobia, abn pupillary response, decrease visual acuity,

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9
Q

rare but highly m&m complication of orbital cellulitis?

+ other ones?

A

cavernous sinus thrombosis, presents with HA and deficit of CN 3, 4, 6

meningitis, encephalitis, epidural abcess, brain abcess.

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10
Q

dx and tx of orbital cellulitis?

A

dx: clinical + CT can also make dx
tx: IV ABX, ophtho consult, lateral canthotomy if inc IOP

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11
Q

abx for orbital cellulitis secondary to sinusitis?

A

ctx and flagyl

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12
Q

what is stye/hordeolum?
how is it managed

A

acute bacterial infection from blockage of glands. think “pig stye”, “whoredeolum”, therefore dirty compared with chalazion

usually loacted at lid margin/las line

tx: warm compress, erythro ointment

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13
Q

what is chalazion?
how is it managed

A

acute or chronic inflammation, no infection.
warm compress
ophtho if not resolving or if vision affected

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14
Q

blepharitis, most common cause and tx

A

overgrowth of s epidermidis
tx: lid hygiene (wipes) abx oint if severe

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15
Q

3 rule outs in bacterial conjunctivitis

A

corneal ulcer (look before fluorescein) then, abraision and herpetic lesions (with fluorescein)

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16
Q

how long for viral conjunctivitis to resolve?

A

1-3 weeks, very contagious

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17
Q

triggers for sub conjunctival hemm?
how long to resolve?

A

trauma, valsalva, HTN, spontaneous
about 2 weeks

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18
Q

Herpes simplex vs herpes zoster fluorescein finding?

A

Dendritic lesion, compared to HZO which has pseudodendrite (poorly staining mucous plaque), no actual erosion which true dendrite has

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19
Q

herpes zoster ophatlmicus treatment

A

Oral antivirals

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20
Q

corneal ulcer etiologies

A

Exposure kerstitis (eg Bell’s palsy)
Trauma
Direct microbial invasion
Contact lenses that
Ocular surgery

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21
Q

corneal ulcer signs/symptoms

A

Redness swelling if lids and conjunctiva
Discharge
Ocular pain
Fb sensation
Photophobia
Blurred vision
You see a corneal opacification with slit lamp and flare and cells in ant chamber

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22
Q

corneal ulcer mgmt

A

Emergent ophtho consult
Start cipro drops; usually after cultures taken by ophtho so just call them

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23
Q

What is Hutchinson sign?

A

Shingles lesions at top of nose, predicts corneal involvement

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24
Q

Mgmt HSV keratocomjunctivitis

A

Topical antivirals: topical acyclovir, ganciclovir or trifluridine
Can also add oral antivirals
Defs add oral if there are lesions on the adnexa

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25
What nerve is involved in HZO
V1 (ophthalmic nerve)
26
Some organisms that cause corneal ulcer
27
What is ultraviolet keratitis
Damage to cornea from ultraviolet light. A.k.a. snow blindness or welders arc. Can also be from tanning beds. Symptoms of pain developed 6 to 12 hours later. Can have photophobia. Resolve on its own and 24 to 36 hours.
28
Anterior uveitis is synonymous with?
Iritis
29
Causes of anterior uveitis
Systemic inflammation: ulcerstive colitis, ankylosing spondylitis, bechets, sarcoid Infections: tuberculosis, Lyme disease, HSV, syphilis Malignancy: leukemia, lymphoma, melanoma Trauma, foreign body
30
Signs and symptoms of anterior uveitis
Red eye, photophobia, decreased visual acuity. Findings of associated systemic disease. Perilimbal flush, a.k.a. ciliary flush, usually no discharge Cells and flare consensual photophobia is highly suggestive.
31
3 causes, in order, of endopthalmitis (infection of vitreous or aqueduct humour)
Post eye surgery Penetrating trauma Hematogenous spread
32
Signs and symptoms endopthalmitis
Pain, redness, discharge Hypopion, photophobia, ciliary flush Can have adnexal swelling RF of surgery or fb paramount
33
Symptoms of vitreous hem/detachment
Painless vision loss, flashers floaters, haziness Usually send to ophtho to r/o retinal detachment after doing full eye exam
34
ABX for corneal abrasion, contact wearer vs non-contact wearer
Non: erythro ointment Wearer cipro ointment, ofloxacin ointment
35
Similar to corneal abrasion and laceration there is…..
Conjunctival. Similar exam, usually less symptoms. Mgmt is the same
36
Why abx in corneal abrasion
Prevent iritis, they are a must!
37
Relief of pain with topical anesthetics is almost diagnostic for?
Corneal abrasion Very painful, pain can be delayed by a few hours after injury,
38
Best analgesics for corneal abrasion
Simple oral analgesics, nsaids best
39
Exam finding ls for corneal laceration
Misshapen iris, hyphema, Seidel test shallow anterior chamber
40
If clinical suspicion for penetrating eye injury or severe blunt trauma do?
Consult ophtho and get ct of orbit. Even if ct normal need to consult
41
corneal FB removal?
anesthetize eyes (somtimes freezing both helps): NS rinse moist cotton applicator 25 g needle
42
when does rust ring appear
when metal fb present for more than a few hours
43
when to be worried about globe rupture from fb?
hyphema, seidel sign or seen to be deeply embedded on slit lamp
44
is it necessary to remove rust ring in the ED?
no, can refer to ophtho, but should still try and get fb out
45
criteria for ophtho to see lid lacerations
lid margin, 6-8 mm from medial canthus, involving lacrimal duct, inner surface of lid, ptosis or involving tarsal plate and most full thickness so basically all of them....?
46
in full thickness lacerations what needs to be ruled out?
globe rupture/corneal laceration
47
how to know if canalicular system is cut
put fluorescein in eye and if it comes out the wound, its cut
48
which type of lid lacerations are the ones repaired in ED and how
partial thickness not meeting criteria: lid margin, 6-8 mm from medial canthus, involving lacrimal duct, inner surface of lid, ptosis or involving tarsal plate and most full thickness use 6 or 7-0 soft suture. can try and hold ends down with subsequent suture
49
If lid margin lac cannot be repaired by optho, describe how to do it
Note not necessary if less than 1mm
50
how to get eyelids open in blunt eye trauma
eye speculum or can use paperclips bent in proper way
51
if restricted EOM in blunt ocular trauma think?
orbital blowout fracture, need to get CT facial bones/orbits
52
things to check in blunt ocular trauma
acuity, globe integrity, IOP, EOM
53
two most common spots for orbital blow out fracture
inferior wall (maxillary sinus) medial wall (lamina papyracea aka ethmoid)
54
how to manage suspected or confirmed golobe rupture?
HOB 45 degrees, cover eye with paper cup, broad spectrum IV abx, immediate ophtho consult
55
signs of globe rupture? none are overly sens or specific
large sub con hemm, chemosis (raised sub con hemm) ,seidel's sign, shallow anterior chamber, hyphema, tear drop shaped pupil, decreased acuity
56
imaging to detect occult globe rupture?
CT of eye
57
what is post septal hemorrhage
aka orbitla hematoma secoanr to trauma, causes orbitla compartment syndrome
58
clinical features of post septal hemorrhage?
eye pain, proptosis, impaired EOM, elevated IOP, decrease acuity can also get oribital CT scan if unsure
59
indications for lateral canthotomy and cantholysis
retrobulbar hemm with IOP > 40, if IOP < 40 but dx is suspected get a CT or retrobulbar hemm with RAPD, ophthalomoplegia, cherry red macula, optic nerve head pallor or severe pain in affected eye
60
walk through steps of lateral canthotomy and cantholysis
go!
61
retinal ischemic time in orbital compartment syndrome
90-120 mins
62
only contraindication to lateral canthotomy and cantholysis
globe rupture
63
mgmt in chemical ocular injury
-Morgan lens and wash with 1-2 L of NS, then examine (washout before testing visual acuity) -can check pH first -irrigate until pH is between 7 and 7.4, re-check 30 mins after irrigation and continue to irrigate if pH is out of range
64
how to get super glue out of eye
apply tons of erythro ointment, which loosens it, remove what comes off easily. tell pt to keep applying erythro ointment and arrange ophtho f/u
65
treatment for acute angle closure glaucoma?
TAPAM timolol drops 1 drop bid acetazolamide 500 po/iv pilocarpine drops analgesics (opiods lower pressure) mannitol if refractory (ie IOOP > 40 after 1 hour) check re check IOP hourly
66
basic pathophys of acute angle closure
lens or iris blocks trabecular meshwork stopping aqueous humor from exiting eye
67
what usually triggers acute angle closure glaucoma?
anything that dilates pupil (anticholinergics, sympathomimetic, emotional stress, dim lighting)
68
signs and symptoms of acute angle closure glaucoma?
symp: HA, decreased vision, eye pain, n/v signs: raised IOP, fixed, mid dilated pupil, hzy cornea, conjunctival injection, eye is "rock hard"
69
is optic neuritis painful
usually mild to mod pain, but can be painless
70
timeline of optic neuritis?
vision loss over days or hours, usually unilateral can be profound or just bluriness
71
CRAO: what is it? epidemiology s/s mgmt
-central retinal artery occlusion - ischemic embolic stroke of eye (1st branch off ICA is ophthalmic artery) -quite rare, age > 50, same rf as stroke -sudden painless vision loss (monocular); pale retina (pale bc no flow) with cherry red spot -ophthalmic emergency, consult ophtho stat, irreversible vision loss after 4 hours
72
CVAO: what is it? epidemiology s/s mgmt
central retinal vein occlusion - thrombus of vein - same rf as stroke -"blood and thunder" ie diffuse retinal hemorrhage, presents as rapid painless monocular vision loss -no consensus treatment, consult ophtho
73
important initial distinction for "flashers and floaters"
monocular vs binocular bi: intracranial mono: ocular
74
mgmt for ?retinal vs vitreous detachment
ophtho consult for dilated exam
75
symptoms/signs of retinal detach
flasher/floaters, curtain over field of vision, visual field deficit, decreased central or peripheral visual acuity
76
age at which to consider GCA?
>50
77
symptoms GCA
HA, jaw claudication, fever, myalgias, decreased vision, temporal artery tenderness
78
blood test to r/o GCA
CRP or ESR
79
if you suspect GCA what do you do
high dose steroids, arrange biopsy with ophtho
80
What is a pcomm artery aneurysm until proven otherwise?
Acute cranial nerve 3 palsy (down and out) with ipsilateral pupillary dilatation
81
what is horner's syndrome triad? what causes it?
ptosis, miosis, anhidrosis causes: stroke, tumor, ICA dissection, HZV, trauma if neck pain and horners = carotid dissection

CCFP EM (22 decks)

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