Ophthomology

Question 1

Leading infectious cause of blindness worldwide

Answer 1

Trachoma

(Chlamydia trachomatis serotype A-C; genital infections are caused by serotypes D-K)

• Most common in children; seen in refugee camps; transmitted via contact or flies
• Painless follicular conjunctivitis (white-yellow follicles on inflamed upper tarsal conjunctivae) that p/w mild eye redness watering, and itching.
• Tx = Azithromycin for entire community
• Repeated or chronic infection (cicatricial phase) leads to scarring of the eyelids and inversion of the eyelashes (trichiasis). Over time, the lashes rub the eye, causing painful ulcerations and eventually blindness.

Question 2

Orbital tissue expansion of the eyes describes the pathology of what disease?

Answer 2

Graves Ophthalmopathy (Graves Disease)

• Lid lad
• Proptosis
• Diplopia
• Exophthalmos w/ impaired extraocular motion due to T cell activation and stimulation of orbital fibroblasts & adipocytes by TRAB (TSH-Receptor Abs), resulting in orbital tissue expansion and lymphocytic infiltration.

Question 3

Ectopia lentis (lens dislocation) following minimal or no trauma should prompt evaluation for _____

Answer 3

Marfan Syndrome

• Echocardiography to detect associated aortic root disease

Question 4

Acute corneal injury caused by UV light exposure in the absence of UV-protective eyewear

Answer 4

Photokeratitis

(basically ocular sunburn)

• Wear sunglasses
• Treat symptomatically w/ oral analgesics + lubrication w/ topical abx like erythromycin
• Sx resolve in 1-3d
• Usually p/w surrounding sunburn around face
• Dx confirmed w/ fluorescein staining of punctate defects on BL corneas
• UV radiation can lead to other sequelae such as pterygium or cataracts

Question 5

Aqueous humor obstruction

Answer 5

Acute angle-closure glaucoma

Question 6

Relative afferent pupillary defect (RAPD)

Answer 6

Optic nerve injury

Question 7

MCC of eye discharge in infants

Answer 7

Dacryostenosis

(Congenital Nasolacrimal Duct Obstruction [NLD])

• Tx: Lacrimal sac massage w/ downward pressure performed several times daily to open the duct.
• Most spontaneously resolve in the first few months of life; if persists beyond 6mo, ophtho eval for surgical tx (NLD probing)

Question 8

Esotropia

Answer 8

Inward conversion of eye

(when one or both eyes cross toward your nose)

Question 9

Optic pathway gliomas are associated with

Answer 9

Neurofibromatosis Type 1

Question 10

Itching or burning of the eyelids, discharge, crusting of the eyelashes in the morning, eyelid swelling & redness, and foreign body sensation in the eye; can p/w seborrheic dermatitis

Answer 10

Blepharitis

(eyelid inflammation)

[Greek, from blepharon, eyelid.]

Question 11

Ophthomologic condition seen in MS pts

Answer 11

Optic neuritis

(Dx: optic disc edema on fundoscopy)

Question 12

Anisocoria

Answer 12

Unequal pupils

Question 13

Biggest risk of Hyphema (collection of blood in anterior chamber of eye that develops following blunt or penetrating ocular trauma)

Answer 13

Intraocular Hypertension

(↑IOP)

Question 14

Fluorescein uptake followed by clearing in a waterfall pattern (Seidel sign)

Answer 14

Full-thickness corneal laceration with OGI (Open Globe Injury)

• When just localized fluorescein uptake = diagnostic of corneal abrasion

Question 15

Chlamydial conjunctivitis presentation window and Tx?

Answer 15

5-14d

Oral Erythromycin

Question 16

Gonococcal Conjunctivitis presentation window and Tx?

Answer 16

2-5d

IM CTX or Cefotaxime

Question 17

Gonococcal Conjunctivitis PPX in Newborn?

Answer 17

Topical Erythromycin

(does NOT prevent chlamydial disease)

Question 18

Herpes Zoster Ophthalmicus is characterized by a painful dermatomal rash and eye involvement from reactivation of VZV in the ___ division of the Trigeminal nerve

Answer 18

V1

Tx: Systemic Antiviral Therapy

Question 19

Chemosis

Answer 19

Conjunctival swelling

Question 20

Progressive and bilateral loss of central vision

Answer 20

Age-Related Macular Degeneration (AMD)

• Age >50
• Peripheral fields & navigational vision intact

Question 21

Most common end-organ complication of CMV in those with advanced AIDS

Answer 21

CMV Retinitis

Question 22

Most common bacterial infection a/w prolonged Contact Lens use

Answer 22

Pseudomonas

(& Staph aureus)

• Tx: Topical FLQ (moxifloxacin) for Pseudomonas

Question 23

Ophtho complication of Sjögren syndrome

Answer 23

Corneal ulceration

• Corneal perforation
• Dry eyes
• Decreased visual acuity
• Superficial infection

Question 24

White Reflex

Answer 24

• Retinoblastoma (<2yo, UL, +strabismus, +nystagmus)
• Cataracts 2/2 CMV (BL, +hearing loss)
• Cataracts 2/2 Rubella (BL, +hearing loss)
• Retinopathy of prematurity (if <30w GA)

Question 25

Distortion of straight lines such that they appear wavy on Visual Grid Test

Answer 25

Macular Degeneration

Question 26

Dendritic ulcers on Cobalt Blue slit lamp (or green slit lamp)

Answer 26

HSV Keratitis