Opthal Flashcards
purulent discharge, eyelashes stuck together in the morning, blurring of vision clears with blinking
bacterial conjunctivitis
17 y/o girl, hay fever history, no discharge and itchiness, conjunctival injection. Glassy appearance
atopic conjunctivitis
treatment of allergic conjunctivitis
mast cell stabilizers: olopatadine
what eye condition is associated often with seborrhoeic dermatitis and/or rosacea? What is the treatment for it?
blepharitis.
Tx: lid hygiene (clean eyelid with warm water and wash away crusting on the lashes and eyelid margins) + topical lubricants. Oral tetracyclines - can give for 2 - 3 months in severe cases
gritty uncomfortable eyes when straining eyes (reading, watching TV, driving). what is it and how do we treat it?
dry eyes
tx: w/ artificial teardrops
spontaneous, painless, normal vision, retinal bleeding (in patches)
sub conjunctival hemorrhage - harmless, reassure and will resolve
tx: may be associated with HTN and heavy coughing/straining
what not to give during corneal abrasion and why?
topical anesthesia - because it reduces wound healing and it is toxic to the epithelium
what is the treatment for recurrent corneal abrasion?
use lubricating eye ointment at night and tear drops during the day
what is wearing lenses associated with
corneal ulcer - often assoc. with wearing lenses on too long
eye pain and wearing contact lenses. what is the next most important form of investigation
fluorescein staining of the eye
What treatment do you NOT give when patient presents with possible HSV viral keratitis. Why?
no steroid drops - may cause perforation
painful eye (boring pain), mild photophobia, redness localized around the limbus (edge of cornea), reduced visual acuity, 35 y/o man
iritis, anterior uveitis, irido-cyclitis
what are the gene assoc. w/ iritis?
HLA-B27 - only worth investigating with recurrent episodes
posterior synechiae (irregular shaped pupil) with slight redness. what is it?
iritis - late sign of iritis.
what are some recurrent eye disease?
iritis
herpes simplex
corneal abrasion
what is the treatment of iritis?
topical steroids
topical cyclopentolate
82 y/o, acute eye pain behind the eye, radiates to forehead, abdominal pain and vomiting, impaired vision
acute closed angle glaucoma - emergency
risk factors for acute glaucoma?
age older than 40 - 50 y/o female positive fmhx hx of acute glaucoma hypermetropia/long sightedness
acute eye pain, mid dilated, fixed pupil, abdominal pain and vomiting
acute closed angle glaucoma
what is the treatment of acute glaucoma?
reduce aqeous secretion with IV acetazolamide
pupillary constriction w/ pilocarpine drops
surgical/laser iridotomy
78 y/o women with 3 day Hx of painful rash on the RHS side of forehead. RHS eye is inflamed and photophobic.
shingle (herpes zoster opthalmicus)
what is the organism usually associated with a stye/
s. aureus
what is the treatment of a stye?
hot compresses w. flannel 3 - 4 times daily, ease pain and draw pus to head
no real treatment
superifical tissue swelling around eye, painful eye movement, slight proptosis, quite unwell
orbital cellulitis - often caused by existing sinusitis
Bilateral eye swelling aroudn the periorbital area. most possible dx?
allergy - most commonly chloramphenicol
what are some eye conditions that require urgent referral?
corneal ulcer iritis acute closed angle glaucoma herpes zoster opthalmicus w/ orbital involvement hyphaema d/t injury penetrating eye injury - high speed injury, welding etc. severe chemical burns orbital cellulitis any patient w/ SEVERE eye pain
what are some high risk factors for eye conditions in history taking?
metal welding
contact lens wearers
haloes, vomiting, pain
past medical history (corneal abrasion, iritis, herpes simplex keratitis)
what symptoms should we refer for patients?
pain
photophobia
blurred vision
young child with squinting eye, what important ddx to rule out?
retinoblastoma
neurofibromatosis
what are the important diagnoses to consider in the unilateral red eye?
FUGIT: foreign body, ulcer, glaucoma, iritis, trauma
management of foreign body (post care)
put gauze over eye
uniocular - cannot drive
use chloramphenicol drops + ointment - 2 hours
see daily - fluorescein stain
management of chemical injury
1st aid: irrigation for 20 minutes -buffered normal saline
referral to opthalmo
what is the fundoscopy finding of a patient w/ glaucoma?
increased cup to disc ratio
Asymmetry of the cup:disc ratio in the optic nerve between 2 eyes
ddx: painless LOV w/ loss of direct pupil response (Marcus Gunn)
optic neuritis
central retinal artery occlusion
temporal arteritis
ddx: LOV that is corrected by 1mm pinhole
refractive error
dangerous ddx of the unilateral red eye
foreign body, penetrating eye injury
corneal ulcer
acute glaucoma
iritis
complication of eyelid ulcer?
BCC
treatment of penetrating eye injury
sterile pad - do not use eye drops or ointments
NBM
if treatment has to be delayed, give ttetanus, systemic antibiotics
give analgesics, anti-emetics, and sedation if required
urgent referral
what is the treatment of chemical burns
irrigation with saline or water for 15 minutes
instill local anesthetic to evert and swab the eyelids
urgent referral to ED
what is the sign of hutchinson’s sign and its significance?
Herpes zoster opthalmicus involvement of the nose (nasociliary nerve) which means that there is very likely to be involvement of the eye
requires early systemic treatment and assessment by the opthalmologist
spot diagnosis: LOV w/ flashing lights
retinal detachment
posterior vitreous detachment
spot diagnosis: LOV w/ colored haloes around
glaucoma
spot diagnosis: LOV w/ zigzag lines
migraines
spot diagnosis: central scotoma and LOV
macular disease
optic neuritis
spot dx: LOV with repeated walking into a side of the vision
homonymous hemiapnoia
bitemporal hemiapnia
spot dx: peripheral LOV first
glaucoma
spot dx: LOV w/ headache
temporal arteritis
migraine
benign intracranial HTN
spot dx: distortion, wavy straight lines on the Amsler chart
Macular degeneration (wet, dry)
what are some iatrogenic cause of LOV
ethambutol
quinine/chloroquinine
amiodarone
spot dx: LOV w/ problems with glare while driving
cataracts
common causes of LOV in a child
cortical blindness
optic atrophy
choroidoretinal degeneration
cataracts
urgent referrals required for children?
strabismus nystagmus wandering eyes lack of fixation or following of movements photophobia opacities
ddx acute loss of vision less than 1h
amaurosis fugax CVA acute glaucoma migraine central retinal artery occlusion vitreous hemorrhage
ddx slow gradual loss (chronic) of vision
compression of visual pathways chronic glaucoma (open angle) cataracts diabetic maculopathy retinitis pigmentosa macular degeneration refractive errors
difference between wet and dry macular degeneration
dry (mostly painless, develops slowly)
wet (acute, neovascularization of mebrane under the retina of the macular area, serious disorder that requires urgent referral)
signs of optic neuritis?
central scotoma
discomfort while eye movement
afferent pupillary defect on affected eye
treatment of optic neuritis?
IV steroids - hasten recovery and protective effect against development of further demyelinating episodes
other management steps: test visual field of other eye, use MRI
what is normal ocular pressure? what is glaucoma ocular pressure?
12 - 22 mmhg. glaucoma > 40
opthalmoscopy finding of retinal vein thrombosis
multiple retinal hemorrhages w/ stormy sunset apperance
swollen optic disc
what are the associations with retinal vein thrombosis?
HTN DM Anemia Glaucoma Hyperlipidemia
afferent pupillary defect is found in?
optic neuritis
central retina artery occlusion
temporal arteritis
what does myopia predispose you to?
retinal detachment
treatment of chronic open angled glaucoma?
acetazalomide timolol drops pilocarpine drops latanodrops dipivefrine drops
treatment of central retinal artery occlusion
massage eye area through closed eyelids (rhythmic massage)
rebreathe CO2 in bag
IV acetazolamide 500mg
urgent referral
findings of diabetic retinopathy (prolif and non prolif)
prolif: neovascularization, hard exudates, vitreous hemorrhage
non prolif: cotton wool spots, dot and blot hemorrhages, microaneurysms
eye condition assoc. wiht ank spond
anterior uveitis
treatment of diabetic retinopathy
most pt do not need treatment
preventive treatments:
modify risk factors and good diabetic control
ddx: acute LOV in the painless eye
amaurosis fugax CVA optic neuritis retinal artery occlusion retinal vein occlusion wet acute macular degeneration vitreous hemorrhage
ddx: acute painful red eye
glaucoma iritis corneal ulceration/abrasion foreign body, penetrating injury scleritis/episcleritis conjunctivitis herpes zoster opthalmicus, herpes simplex endopthalmitis
ddx: eyelid bump and lump
stye chalazion lipoma preseptal, orbital cellulitis molluscum contagiosum dacryocysititis neoplasm: BCC blepharitis
ddx: chronic LOV in quiet eye
corneal scarring - trachoma cataracts diabetic retinoathy open angled glaucoma posterior vitreous detachment macular degeneration (dry) optic atrophy optic chiasm pathology iatrogenic cause: drugs
ddx: things in the eye
conjunctivitis scleritis/episcleritis entropion keratoconjunctivitis secca (dry eyes) foreign body corneal ulcer, abrasion bell's palsy herpes simplex keratitis
ddx: flashes and floaters
posterior vitreous detachment retinal detachment migraines optic neuritis retinal artery occlusion vitritis diabetic retinopathy
