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LMCC > Ophtho > Flashcards

Ophtho Flashcards

1
Q

Most common signs of retinoblastoma

A

Leukocoria

Esotropia

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2
Q

Corneal light reflex in strabismus

A

No response in affected eye

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3
Q

Red reflex in strabismus

A

Red reflection is MORE intense from deviated eye

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4
Q

Amblyopia

A

Eye fails to achieve normal visual acuity even with prescription glasses or contact lenses
Occurs in up to 1/2 of younger children with strabismus

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5
Q

Myopia

A

Nearsightedness

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6
Q

Hyperopia

A

Farsightedness

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7
Q

Internuclear ophthalmoplegia

A

Caused by lesion of MLF in mid-pons
Disorder of horizontal eye movements: affected eye unable to ADduct, contralateral eye able to ABduct but with nystagmus
Unilateral (commonly caused by stroke)
Bilateral (commonly caused by demyelning disorder ie. MS)
Ex. Right MLF lesion causes Right INO (unable to adduct right eye when looking left)

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8
Q

Giant cell arteritis presentation

A 
Unilateral vision loss (often) 
Headache
Jaw claudication
Scalp tenderness
Constitutional symptoms
High ESR/CRP
RF: age, female, smoking, low BMI, PMR
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9
Q

GCA tx

A

1st step: high dose pred for months-years (usually switched to immunosuppression)

  • Temporal artery biopsy
  • Urgent referral to ophtho and rheum
  • If left untreated, will involve other eye within 2 weeks
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10
Q

Optic neuritis presentation, etiology

A 
Young females
Reduced colour vision
Pain with EOM
Visual field defect
Often due to MS
May be idiopathic
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11
Q

Optic neuritis tx

A

Refer to ophtho and neuro
MRI MS protocol
High dose IV steroids

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12
Q

Retinal vascular occlusion: Arterial occlusion etiology, fundoscopy

A

May be caused by embolism (stroke workup), inflammation (GCA, vasculitis)
Fundoscopy: retinal pallor due to ischemia, cherry red spots (fovea appears red compared to surrounding retina)

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13
Q

Retinal vascular occlusion: Venous occlusion etiology, fundoscopy

A

Older pt with microvascular dz, atherosclerosis (arteries squish the veins)
Younger pt with hyperviscosity due to polycythemia, myeloma, etc.
Fundoscopy: cotton wool spots (areas of ischemia, hemorrhage)

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14
Q

Retinal detachment

A

Black curtain, flashes of light (photopsia), floaters
Macula on –> emergency, needs to be fixed before macula comes off; pinhole correction means NO fovea involvement
Macula off –> not an emergency anymore; no pinhole corection means fovea involved, will not be able to regain vision

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15
Q

Vitreous detachment

A

Normal part of aging
Floaters and flashes
All need dilated retinal exam to rule out retinal tear/detachment within a few days
No good tx for floaters

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16
Q

Lesion of optic nerve

A

Ipsilateral monocular vision loss

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17
Q

Lesion of optic chiasm

A

Bitemporal hemianopsia

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18
Q

Lesion at optic tract

A

Contralateral homonymous hemianopsia

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19
Q

Cataracts symptoms

A 
Blurred vision
Glare 
Difficulty seeing in low light 
Loss of contrast sensitivity 
Loss of ability to discern colours 
Change in refractive status
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20
Q

Cataracts surgical guidelines

A

Visual acuity 20/50 or worse WITH glasses
Visual acuity 20/40 or better but with significant visual impairment
Always up to the patient, except
Driving (must be 20/50 or better)
Angle closure glaucoma

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21
Q

Macular degeneration: dry type

A

More common
slow progressive atrophy of RPE and photoreceptors
Characterized by Drusens in macula
Tx: Smoking cessation, vitamins

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22
Q

Macular degeneration: wet type

A

RPE detachment and choroidal neovascularization
Leaky vessels
Tx: Anti-VEGF injections

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23
Q

Symptoms of macular degeneration

A

Progressive and bilaterall loss of central vision, metamorphopsia, distortion of vision, scotoma or blind spot

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24
Q

Open angle glaucoma

A

Chronic decreased outflow or increased production of aqueous fluid
Increased cup-to-disc ratio
Slow loss of peripheral vision, asymptomatic
Tx: Lower IOP with drops (prostaglandins ie. latanoprost better than beta blockers ie. timolol), laser or surgery as last line

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25
Q

Cataract

A

Opacity of lens

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26
Q

Closed angle glaucoma

A

Mechanical blockage of fluid flow to anterior chamber, closing angle between lens and cornea
N/V, headache, acute changes in vision, pupil fixed in mid-dilation
IOP up to 40-60

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27
Q

Normal IOP

A

10-22mmHg

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28
Q

Closed angle glaucoma tx

A 
Emergency
Eye drops (ie. timolol) 
IV diamox (carbonic anhydrase inhibitor to decrease fluid production)
IV mannitol
Check kidneys!
Laser peripheral iridotomy
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29
Q

Diabetic retinopathy on fundoscopy

A 
Nonproliferative: Microaneurysms 
Retinal hemorrhage 
Cotton wool spots 
Proliferative (worse): ischemia of retina with neovascularization
Any stage: 
Macular edema
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30
Q

Diabetic retinopathy tx

A

Control diabetes
Non-proliferative - no tx
Macular edema - anti-VEGF
Proliferative - laser photocoagulation, anti-VEGF injection, vitrectomy

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31
Q

Emmetropia

A

No refractive error

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32
Q

Astigmatism

A

Light rays not refracted uniformly due to non-spherical surface of cornea or non-spherical lens
May cause blurry vision, squinting, headaches

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33
Q

Anisometropia

A

Difference in refractive errors btwn eyes

2nd most common cause of amblyopia in children

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34
Q

Preseptal cellulitis tx

A

Systemic abx to cover S. aureus, Strep, H. influenza if child
Ie. Amox clav

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35
Q

Septal cellulitis tx

A

Admit
Blood cultures x2
Orbital CT
IV abx (CTX + Vanco x 1wk)

36
Q

Hordeolum

A

Stye
Acute inflammation of eyelid gland (Meibomian, glands of Zeis or Moll)
Infectious agent typically S. aureus
Tx: Warm compresses, lid care, gental massage)

37
Q

Chalazion

A

Chronic granulomatous inflammation of Meibomian gland often preceded by internal hordeolum
NOT infectious case

38
Q

Blepharitis

A

Inflammation of lid margins
S. aureus, seborrheic, meibomian gland dysfunction
Warm compresses, lid massage, lid washing, topical/systemic abx as needed

39
Q

Viral conjunctivitis common culprit

A

Adenovirus

40
Q

Bacterial conjunctivitis common causes

A 
S. aureus 
S. pneumo
H. influenza
M. catarrhalis 
N. gonorrhoeae, C. trachomatis in neonates
41
Q

Most common cause of bacterial conjunctivitis in neonates

A

C. trachomatis

42
Q

Leading infectious cause of blindness in world

A

Trachoma

43
Q

Trachoma tx

A

Oral azithro and topical tetracycline

44
Q

Episcleritis vs scleritis

A

Phenylephrine drop –> reexamine 10-15min later

Episcleritis = episcleral vessles blanch with phenylephrine

45
Q

Corneal abrasion tx

A

Topical abx
Topical NSAIDs
Cycloplegic
Patch

46
Q

Corneal ulcer

A

Corneal opacity stains with fluorescein
Seidel test: Fluorescein under cobalt blue filter –> leaking penetrating lesions
Tx: URGENT referral to ophtho, culture prior to tx, topical abx q1h

47
Q

Herpes simplex keratitis

A

Usually HSV1
Dendritic lesion with terminal end bulbs in epithelium that stains with fluorescein
Tx: Topical or systemic antiviral, NO STEROIDS initially (only done by ophtho)

48
Q

Herpes zoster ophthalmicus

A

CNV1

Tx: Oral antiviral immediately, topical steroids/cycloplegia as indicated, erythromycin ointment if conjunctiva involved

49
Q

Hutchinson’s sign

A

If tip of nose is involved, globe will be involved in 75% Of cases

50
Q

Most common cause of reversible blindness worldwide

A

Cataracts

51
Q

Most common surgical technique for cataracts

A

Phacoemulsification

52
Q

New or markedly increase in floaters or flashes of light require dilated fundus exam to R/O

A

Posterior vitreous detachment/retinal detachment

53
Q

Retinal artery occlusion hallmark on exam

A

Cherry red spot atcentre of macula

also retinal pallor, cotton wool spots, cholesterol emboli

54
Q

Retinal artery occlusion presentation

A

Sudden, painless, severe monocular loss of vision

55
Q

Retinal artery occlusion tx

A

OCULAR EMERGENCY
Needs to attempt to restore blood flow within 2h
Ocular massage and high flow O2
Decrease IOP (topical BB, IV acetazolamide, IV mannitol)

56
Q

Central retinal vein occlusion hallmark on exam

A

Blood and thunder:

Diffuse retinal hemorrhages, cotton wool spots, venous engorgement, swollen optic disc, macular edema

57
Q

Leading cause of irreversible blindness in western world

A

Age related macular degeneration

58
Q

Most common cause of age related macular degeneration

A

Dry/Non-exudative/non-neovascular

59
Q

Characteristic finding of dry AMD

A

Drusen - yellow/white deposits btwn RPE and BRuch’s membrane

60
Q

Characteristic finding of wet AMD

A

Chorionic neovascularization

61
Q

Classic clinical feature of AMD

A

Variable degree of progressive central vision loss

Metamorphsia

62
Q

Wet AMD tx

A

Intraveitreal injection of anti-VEGF

63
Q

Pressures > ___ increase risk of developing glaucoma

A

21mmHg

64
Q

Primary open angle glaucoma

A

Resistance from trabecular meshwork
Earliest signs are optic disc changes (Increased C:D ratio)
Slow progressive irreversible loss of peripheral vision

65
Q

Primary open angle glaucoma tx

A

Increase aqueous outflow (topical cholinergics, topical prostaglandins, topical alpha adrenergics)
Decrease aqueous production (topical beta blockers, topical and oral carbonic anhydrase inhibitors, topical alpha adrenergics)
Surgery

66
Q

Acute angle-closure glaucoma

A 
Fixed mid-dilated pupil 
RF: hyperopia, pupil dilation, asian female, >70yo, mature cataract 
RED PAINFUL EYE 
Unilateral 
>40mmHg IOP
67
Q

Acute angle closure glaucoma tx

A

Beta-blockers (timolol)/miotics (pilocarpine - increases outflow)
Diamox (Carbonic anhydrase inhibitor to decrease aqueous production)
Hyperosmotic agents (oral glycerine, IV mannitol)
Laser iridotomy is definitive

68
Q

Highly specific sign of neurosyphillis

A

Argyll-Robertson pupil (bilateral small pupils that constrict with accommodation but NOT to light reflex)

69
Q

CN III palsy

A

Eye deviated down and out with ptosis

Pupillary dilation

70
Q

Most common cause of relative afferent pupillary defect

A

Optic neuritis

71
Q

Relative afferent pupillary defect

A

Impairment of direct pupillary response to light caused by lesion in visual afferent (sensory) pathway anterior to optic chiasm
Pupils DILATE in response to rapid swinging of light from unaffected to affected eye
Cannot have RAPD in both eyes

72
Q

Most common malignancy on eyelid

A

BCC

73
Q

Most common primary intraocular malignancy in adults

A

Uveal melanoma

74
Q

Most common intraocular malignancy in adults

A

Metastases

75
Q

Kaposi’s sarcoma secondary to

A

Human Herpes Virus 8

76
Q

Diabetic retinopathy

A

Most common cause of blindness in young people in NA
Non-proliferative –> Proliferative
Tx: DM/HTN control, anti-VEGF injections, vitrectomy if non-clearing vitreous hemorrhage and tractional RD

77
Q

Optic neuritis tx

A

IV steroids with taper to oral form

Can’t start oral form in isolation as this increases likelihood of eventually development of MS

78
Q

Heterotropia vs heterophoria

A

Deviation NOT corrected by fusion mechanism in heterotropia

Deviation IS corrected by fusion mechanism in heterophoria (ie. not seen when pt is focusing with both eyes)

79
Q

Most common primary intraocular malignancy in children

A

Retinoblastoma

80
Q

Strabismus tx

A

Glasses
Occlusion therapy
Sx
Botox

81
Q

Suspected globe rupture initial management

A 
CANT 
CT orbits
Ancef +/- Aminoglycoside IV 
NPO
Tetanus status
82
Q

Alkali or acid burns worse for eyes?

A

Alkali

83
Q

Managing chemical burn

A 
Irrigate immediately
DO NOT attempt to neutralize 
Cycloplegic drops to decrease iris spasm and prevent secodnaey glaucoma 
Topical abx and patching 
Ophtho may rx topical steroids
84
Q

Common mydriatics

A

Dilate pupils
2 classes:
1. Cholinergic blocking (tropicamide) - dilation plus cycloplegia (loss of accomodation)
2. Adrenergic stimulating (ie. phenylephrine) - stimulate pupillary dilatory muscles, no effect on accomodation

85
Q

CMV retinitis

A

Full thickness retinal inflammation causing edema and scarring –> blurred vision, floaters, photopsia –> scarring and possible retinal detachment
Think about in immunocomprised pt ie. HIV (reactivation of latent dz)
Fundoscopy: Yellow-white fluffy hemorrhagic lesions along vasculature
Tx: oral antivirals

86
Q

Hallmark signs of trachoma

A

Follicular conjunctivitis and pannus formation (neovascularization) in cornea

LMCC (22 decks)

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