opthalmology Flashcards by Warren Keyser

Near-sightedness occurs when the
optical power of the eye is too
large and causes light to focus in
______ of the retina.

front

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Viral Conjunctivitis is More common than bacterial
conjunctivitis, Most commonly occurs after an
upper respiratory tract infection with _______
being the most common organism.

Adenovirus

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Viral Conjunctivitis is associated with

Moderate inflammation of the conjunctiva (appears pink).
Watery discharge.
May have a pre-auricular lymph node enlargement.

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Bacterial Conjunctivitis

• Most common organisms are: _________

Staphylococcus aureus and

Streptococcus pneumoniae.

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what are the treatments for Bacterial Conjunctivitis
• Treatment:
– Cultures are not routinely taken and empirical treatment is started.
–

– Alternatives include sulfacetamide or tobramycin.
–

Antibiotic eye drops usually for one week.

– Preferably 3rd or 4th generation fluoroquinolone (ciprofloxacin,ofloxacin, or moxifloxacin))

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In bacterial conjuctivitis Tx, _______ drops can be toxic and cause irritation with prolonged use

Gentamicin

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Iritis is a form of _______ with

inflammation of the iris

uveitis

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what are the Symptoms of Iritis

ocular or periorbital eye pain, 
photophobia,
blurred or cloudy vision.
Redness (near the limbus).
May have an irregular shaped
pupil.

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Iritis

• Treatment:

– Topical Steroid Eye Drops (prednisolone acetate, difluprednate)
– Dilating Eye Drops help prevent synechiae within the eye and with pain
(cyclopentolate, atropine)
– Occasionally Topical Glaucoma Drops (brimonidine, timolol)

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Herpetic keratitis is a common
viral infection that affects the
corneal epithelium, primarily caused by ______

HSV1.

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Patient presents with
unilateral eye redness (can be
bilateral), pain, photophobia,
decreased vision, and tearing, what does shoe most likely have?

Herpetic keratitis

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In Herpetic keratitis, _______ on the ocular surface
shows dendritic epithelial ulcer in
branching pattern with terminal
bulbs.

Fluorescein

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Patient presents with
unilateral eye redness (can be
bilateral), pain, photophobia,
decreased vision, and tearing, what does shoe most likely have?

Herpetic keratitis

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In Herpetic keratitis, _______ on the ocular surface
shows dendritic epithelial ulcer in
branching pattern with terminal
bulbs.

Fluorescein

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what is the Treatment for Herpetic keratitis

– Topical trifluridine Q2H.
– Oral acyclovir 400mg 5x/day or
valacyclovir 1g TID.

– Most cases will resolve
spontaneously within three
weeks. Medication can shorten
the duration.

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• Herpes Zoster Ophthalmicus is a
reactivation of VZV. Represents about
10-25% of all cases of Herpes Zoster
and up to \_\_\_\_\_\_\_  may develop ocular
manifestations.

65%

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Herpes Zoster Ophthalmicus has Dermatological involvement of _____ distribution.

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• Symptoms of Herpes Zoster Ophthalmicus are ?

prodromal period
of fatigue, low-grade fever, unilateral
rash on forehead, upper eyelid and
nose.

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Fluorescein applied to corneal
surface can reveals multiple swollen
lesions with staining around them. what does this patient have?

Herpes Zoster Ophthalmicus

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Herpes Zoster Ophthalmicus

• Treatment:

– Oral acyclovir 800mg 5x/day for 10 days

– Oral valacyclovir 1g 3x/day for 10 days

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Subconjunctival Hemorrhage

• Risks factors:

– Sneezing
– Coughing
– Excessive eye rubbing
– Anti-coagulation
– Trauma (if there is a history then the should have a complete eye exam)

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Benign fibrovascular tumor, UV

induced, often inflammed is called _____?

Pterygium

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Ocular redness without irritation
that resolves spontaneously.
• Typically transient (days to
weeks) in 20-50 year olds.
• Classified as nodular or diffuse.
what is it ?

Episcleritis

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what is the most common form of scleritis?

Nodular 44%

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Scleritis vessels cannot be moved, and _______with phenylephrine, whereas episcleritis does ______ with phenylephrine

do not blanch, | blanch

which autoimmune diseases can be present with scleritis?

``` – Rheumatoid arthritis – Lupus – Sero-negative spondylarthropathies • Wegener’s • Polyarteritis nodosa – Syphilis – Tuberculosis ```

what are the Sx's and presentation of Dry Eye Syndrome

foreign body sensation, blurred vision, reflex tearing. • Condition worsens towards end of the day and activities that require attention – reading, computer work.

• describe Squamous cell carcinoma in the eye.

``` is a malignant epithelial lesion. – Conjunctival intraepithelial neoplasia in which cells have invaded through the conjunctival basement membrane. – Rarely invades the sclera. ```

what is the initial Tx for Squamous Cell Carcinoma

topical chemotherapeutic agents – Interferon-alpha – 5-fluorouracil – Mitomycin C

you see elevated, mobile salmon pink mass on the | conjunctiva, what are you dealing with?

Non-Hodgkin B-cell conjunctival | lymphoma

Angle closure glaucoma may occur with dilation which results in pupillary block after watching television in dark room or certain medications, name the 4 types (a

anticholinergics, antihistamines, tricyclic antidepressants, MAO inhibitors

what causes Angle Closure Glaucoma

Rapid increase in eye pressure due to the iris being pushed forward up against the trabecular meshwork preventing the outflow of aqueous humor.

• May occur with dilation which results in pupillary block after watching television in dark room or certain medications, name the 4 types (a

anticholinergics, antihistamines, tricyclic antidepressants, MAO inhibitors

what are the Sx's of Angle Closure Glaucoma

unilateral severe eye pain, nausea, redness, blurred vision and halos around lights.

on Examination, angle closure glaucoma may show sluggish, mid-dilated pupil, conjunctival injection, ______ cornea and shallow anterior chamber. When palpating the eye it may feel _______

hazy | hard.

In Ocular Burns • Patients present soon after exposure complaining of _____

eye pain, redness, tearing, decrease in vision.

in ocular burns _____ materials are more harmful

alkali

``` In Ocular Burns • Patients present soon after exposure complaining of _____ • • Limbal ischemia is a poor prognostic sign. ```

eye pain, redness, tearing, decrease in vision.

Examination of ocular burns may show ______

conjunctival injection, corneal abrasion or opacity.

In Ocular Burns • ________ is a poor prognostic sign.

Limbal ischemia

Corneal ulcer is an infection of | the ________.

corneal stroma.

what is the treatment for Corneal Ulcer

– For small ulcers (<1mm) may treated hourly with a 3rd or 4th generation fluoroquinolone (ciprofloxacin, ofloxacin, or moxifloxacin). – Larger ulcers require culture to determine the organism. corneal transplant can be performed in certain cases

________ is a progressive disease of the optic nerve that is often associated with elevated intraocular pressure.

• Open angle glaucoma

what is the treatment for Corneal Ulcer • Fortified antibiotics including vancomycin and tobramycin. – Slow healing and can require weeks of therapy. – Once healed can leave a corneal scar with permanent vision loss. – In some cases where the ulcer does not decrease in size despite medical therapy or if the cornea becomes too thin and there is a risk of perforation then a

________ is a progressive disease of the optic nerve that is often associated with elevated intraocular pressure.

• Open angle glaucoma

_______is a gradual clouding of the eye’s natural lens. Purpose of the lens is to focus light on the retina.

Cataracts

what are the causes of cataracts in younger patients

– diabetes – systemic steroids – trauma – radiation

what are the 2 mechanisms of orbit fractures?

``` BUCKLE (ROOF FX IN KIDS) BLOW OUT (FLOOR ADULTS) ```

what do you see in an ORBITAL FLOOR FX

ENOPHTHALMOS (posterior displacement of the eyeball) HYPOGLOBUS (downward displacement of the eye)

thyroid eye disease is a PRIMARY INFLAMMATORY DISEASE OF THE ORBITAL SOFT TISSUE, AUTO-IMMUNE DISEASE (TARGET IS THE ORBITAL ______ ) ASSOCIATED WITH AUTO-IMMUNE THYROID DISEASE (MOST COMMONLY ________). __________ IS NOT THE CAUSE

FIBROBLAST, GRAVES DISEASE, DYSTHYROIDISM

thyroid eye disease ultimately results in ________

Hypertrophy if the extra ocular muscles

basal cell cancer accounts for ____ OF EYELID SKIN Cancer. | COMMONLY INVOLVES _______ EYELID

90%, | LOWER

treatment for basal cell cancer

TREATMENT IS EXCISION WITH MARGIN CONTROL (FROZENS OR MOHS) RECONSTRUCTION > Tarsoconjunctival flap + FTSG (Full thickness skin graft)

what is the TX for NASOLACRIMAL DUCT | OBSTRUCTION

DCR (DACRYOCYSTORHINOSTOMY)

what presentation is seen in chronic NASOLACRIMAL DUCT OBSTRUCTION

``` Epiphora (overflow of tears onto the face) chronic DACRYOCYSTITS (pain, redness, and swelling in the inner corner of the eye) ```

describe the management diabetic retinopathy

Glycemic control Blood Pressure control Screening eye exams Laser photocoagulation Diabetic macular edema – Focal laser PDR – Panretinal photocoagulation

what findings are seen in acute Hypertensive Retinopathy

Retinal hemorrhage Macular edema and exudate Optic disc edema (Papilledema)

describe what you see in Central retinal vein occlusion

- often related to HTN | - dilated veins and extensive hemorrhage

describe what you see inCentral retinal artery occlusion

- ‘stroke’ to eye | - cherry red spot

what is the #1 cause blindness >50 yr old

Age-related Macular Degeneration (AMD)

what is the Tx for Nonexudative (Dry) AMD

antioxidant vitamins

whats is the Tx for exudative (wet) AMD

Anti-VEGF intravitreal injections

describe the management of gluacoma

``` Lower IOP Medications Decrease aqueous production Increase outflow Laser Surgery – with or w/out drainage implants ```