Ophtho Flashcards
What is acute angle closure glaucoma?
Due to meds (anticholinergics such as tolterodine, sympathomimetics, and decongestions) or other stimuli (eg dim light)
Presentation: PAINFUL, sudden-onset eye pain, blurred vision, headache, and nausea; conjunctival erythema, corneal opacification, fixed mid-dilated pupil, n/v
Halos around lights
Dx: gonioscopy (gold standard); ocular tonometry (measures IOP) helpful if urgent ophtho consulation is unavailable
Visual acuity testing.
Performed routinely at age 4, but can be performed as early as age 3 in cooperative children.
What is amaurosis fugax?
Presentation: PAINLESS, rapid, transient (<10min) monocular vision loss; “curtain” descending over visual field
Etiology: retinal ischemia due to atherosclerotic emboli originating from ipsilateral carotid artery
Dx: duplex u/s of the neck
What is anterior uveitis?
Presentation: PAINFUL, red eye assoc. w/ photophobia, tearing, diminished visual acuity
Exam: hazy “flare” in aqueous humor, layering of white cells in the anterior chamber (hypopyon)
Idiopathic or traumaict, assoc. w/ chron’s disease, spondyloarthritis
What is vitreous hemorrhage?
Commonly caused by proliferative diabetic retinopathy.
Presentation: sudden loss of vision and onset of floaters; fundus is difficult to visualize
Tx: conservative - upright position during sleep, which enhances settling of hemorrhage
What is sympathethic ophthalmia/”spared eye injury”?
Characterized by an immune-mediate inflammation of one eye (the sympathetic eye) after a penetrating injury to the other eye.
Etiology: uncovering of “hidden” antigens when natural barrier is defective; immune response against antigens can involve autoantibodies as well as a cell-mediated reaction
Presentation: anterior uveitis, but panuveitis, papillary edema, and blindness may develop
Central retinal artery occlusion.
Acute painless monocular vision loss
Due to embolized plaque from ipsilateral carotid artery; cardioembolic source
Central fovea appears red from underlying choroid (“cherry red spot”)
Transient
Dx: noninvasive imaging of carotids to evaluate for stenosis
Tx: ocular massage and high flow O2 administration
Thombolytics may be useful if initiated w/in 4-6h of visual loss but they are administerd intraarterially. Their efficacy has not been systematically studied.
Detached retina
Light flashes, floaters, “curtain” across visual field starting from the periphery; not transient
Central retinal vein occlusion
Painless, sudden vision loss (or haze) due to venous thrombosis
Can progress to ischemic form that can be painful
Fundoscopy: dilated and tortuous veins leading to scattered and diffuse hemorrhages (“blood and thunder”), disk swelling, and/or cotton wool spots
What is dacryocystitis?
Infection of the lacrimal sac. Occurs in infants and adults over 40yo.
Acute: sudden onset of opain and redness in medial canthal region; sometimes purulent discharge is noted from the punctum.
Some pts present w/ fever, prostration, and elevated WBC
S. aureus and beta-hemollytic strep are the usual infecting organisms
Tx: systemic abx tx
What is episcleritis?
Inflammation or infection of the episclera tissue between the conjunctiva and sclera.
Presentation: acute onset of mild to moderate discomfort, photophobia, watery discharge
Diffuse or localized bulbar conjunctival injection
What is hordeolum?
Abscess located over the upper or lower eyelid.
Usually caused by s. aureus.
Appears as a localized, red, tender swelling over the eyelid
What is chalazion?
Presents as lid discomfort
Chronic, granulomatous inflammation of the meibomian gland.
Appears as a hard, painless lid nodule
What is orbital cellulitis?
Infection POSTERIOR to the orbital septum.
Unilateral and more common in children
Manifested by an abrupt onset of fever, proptosis, restriction of extraocular movements and swoolen, red eyelids.
What is presbyopia?
Common age-related disorder that results from loss of elasticity in the lens which prohibits accommodation (required to focus on near objects)
Classic - tendency of pts to hold reading material at a further distance
Tx: reading glasses
What is macular degeneration?
Leading cause of blindness in industrialized countries
Early finding: distortion of straight lines such that they appear wavy (grid test)
RF: increasing age, smoking
Fundoscopy: drusen deposits in macula
Papilledema
May enlarge blind spot
Viral conjunctivitis.
Pink eye
Most commonly due to adenovirus, causes acute conjunctival injection and water or mucoid discharge.
Usually preceded by viral prodrome (eg fever, pharyngitis)
Sxs typically improve w/in 5 d
Tx: warm or cold compress
+/- antihistamine/decongestant drops
What is strabismus?
Intermittent or constant ocular misalignment usually due to nasal deviation (esotropa) or less commonly temporal deviation (exotropia)
Exam: asymmetric red reflexes or corneal ligh reflexes or a deviation during cover eye test
Cover eye test: performed by askign child to fix gaze on target as examiner covers one eye whil observing movement of the other - normal eye keeps the same position and does not move; misaligned eye shifts to re-fixate on object when normal eye is covered
Esotropria beyond early infancy must be treated to prevent amblyopia (vision loss from disuse of deviated eye)
Tx: patching normal eye (occlusion therapy) to strengthen deviated eye or
blurring the vision of normal eye w/ cycloplegic drops (penalization therapy)
What is age related macular degeneration?
Usually seen in pt age >50.
Presents w/ progressive and bilateral loss of central vision.
Navigation vision (allowing pts to navigate around obstacles in their surroundings and maintain socal independence) is preserved.
Results from degeneration and atrophy of the central retina (macula), retinal pigment epithelium, Bruch’s membrane, and choriocapillaries.
Retinal detachement
40-70yo
Photopsia (flashes of light), floaters (spots in visual field)
“curtain coming down over eyes”
Laser therapy and cryotherapy are done to create permanent adhesions between the neurosensory retina, retinal pigment epithelium, and choroid.
What is proliferative diabetic retinopathy?
In the initial states it is asx.
Pts may later complain of decreased visual acuity.
Neovascularization is the hallmark of proliferative diabetic retinopathy.
Other findings: vitreous hemorrhage and macular edema. These changes may lead to retinal detachment.
What is exudative macular degeneration?
Typically presents as painless, progressive blurring of central vision, which can be acute or insidious.
It occurs bilaterally.
Testing reveals central scotoma.
Growth of abnormal vessels in retinal space on exam.
Sudeen visual loss ma occur if it is complicated by retinal detachment.
What is allergic conjunctivitis?
An acute hypersensitvity reaction caused by environmental exposure to allergens (pollen, animal dander, dust, mold spores)
Presentation: episode intense itching, hyperemia, tearing, and edema of the conjunctiva and eyelids; pts complain of mild photophobia or a dry-eye sensation
Gritty sensation in eye
Hx of atopic disorder such as asthma or seasonal allergies
Condition usually subsides in 24h w/o treatment
Tx: topical agents (antihistamines, vasoconstrictors, mast cell stabilizers, articial tears)
What is anterior uveitis?
Inflammation of the anterior uveal tract, especially the iris.
Discharge is NOT common and if present is not profuse
Usually causes significant pain, miosis, and photophobia, visual loss may be present
No gritty sensation and itching
What is atopic keratoconjunctivitis?
A severe form of ocular allergy.
Presentation: itching, tearing, thick mucus discharge, photophobia, and blurred vision
Different from allergic conjunctivitis due to more severe symptoms w/ a prolonged course, potential visual impairment due to corneal involvement, and thickening of eyelids and surrounding skin
What is viral keratitis?
Infection of the cornea related to HSV or varicella zoster.
Pt typically have corneal vesicles, opacification, and/or dendritic ulcers.
HSV infection
In HIV pts, both HSV and VZV can cause severe, acute retinal necrosis assoc. w/ pain, keratitis, conjunctivititis, uveitis, and fundoscopic findings of widespread peripheral pale lesions and central retinal necrosis.
Tx: oral acyclovir/valcyclovir
CMV retinitis
Painless
Not usually assoc. w/ keratitis or conjunctivitis
Fundoscopic findings: hemorrhages and fluffy or granular lesions around the retinal vessels
What is open angle glaucoma?
More common in African Americans.
Generally asymptomatic in the intiatial stages, followed by gradual loss of peripheral vision over a period of years, and eventual tunnel vision.
Exam: high IOP, cupping of the optic disc w/ loss of peripheral vision
Beta blockers such as timolol effective in initial managment
Laser trabeculoplasty used as adjunctive measure
If there is continuous increase in IOP, surgical trabeculotomy is done.
What is non-proliferative diabetic neuropathy?
Characterized by the dilatioin of veins, microaneursyms, retinal hemorrhages, edema, and hard exudates.
Herpes simplex keratitis
Frequent cause of corneal blindess in the US
Pain, photophobia, blurred vision, tearing, redness
Hx of prior episodes may be present
Usually, the recurrences are precipitated by excessive sun exposure, outdoor occupation, fever, or immunodeficiency
Corneal vesicles and dendritic ulcers are characteristic.
Dendritic ulcer are the most common presentation
Primary dx clinically, although epithelial scrapings show multinucleated giant cells
Tx: oral or topical antiviral therapy
What is herpes zoster opthlamicus?
An infection caused by VZV.
Most episodes occur in the elderly.
Presents w/ fever malaise and a burning itching sensation in the periorbital region.
Exam: vesicular rash in distribution of the cutaneous branch of the 1st division of the trigeminal never.
Conjunctivities and dendrifrom corneal ulcers characterize they eye involvement.
Fungal keratitis
Occurs after injury in agricultural workers or immunocomprised patients.
The cornea shows multiple stromal abscesses.
Ocular rosaceas
Ocular rosacea can involve the cornea, conjunctiva, and lids and causes burning or foreign body sensation, blepharitis, keratitis, conjunctivitis, corneal ulcers, and recurrent chalazia.
Sxs may not be concurrent w/ skin findings.
Mild sxs are treated w/ lid scrubs, topical abx (metronidazole, erythromycin), and ocular lubricants.
What is trachoma?
Due to infection w/ chlamydia trachomatis serotypes A, B, and C.
Acute trachoma presents w/ follicular conjunctivitis and inflammation; plae follicles; pannus (neovascularization) formation in the cornea
Repeated or chronic infection causes inversion of the eyelashes (trichiasis) and scarring of the cornea.
There is often concomitant nasopharyngeal infection (eg rhinohear, pharyngitis)
Dx: clinically be examination of tarsal conjunctiva
C trachomatis may be visible by Giemsa stain exam of conjunctival scraping
Tx: oral azithromycin
If there is trichiasis, eyelid surgery is needed to perserve vision
