Opthalmology Flashcards by Zahra Kalifa

What is leukocoria and what is indicative of?

Leukocoria is abscence of red reflex “becoming white”

Indicative of tumor (retinoblastoma)

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What is the most common intraocular malginancy in children under the age 4

Retinoblastoma

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What is the clinical presentation of retinoblastoma

leukocoria
strabismus
poor vision
red painful eye
proptosis

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What is the finding in the imaging for retinoblastoma?

Calcifications within tumor

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What is the imaging modality of choice for retinoblastoma?

MRI brain and orbit

“Never CT”

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What are the goals of RB therapy?

Preservation of
1- Life
2- Globe
3- sight

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What is the treatment of choice in RB?

Enucleation (large - optic nerve affected)
laser (stop vasculature)
cryotherapy (freeze) +- chemotherapy (ocular\intra arterial)
external beam radiotherapy

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What is the follow up plan for retinoblastoma?

Every 4-6w for EUA
for RB1 genetic type
systemic follow up for metastasis

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In RB familial type, we should find

RB1 gene

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Are the patients with sporadic RB have any genetic mutation

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What is cataract

Opacification of lens

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What is the most common inheretence of cataract in KSA

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What are the associated systemic disease in cataract?

1- galactosemia
2- hypoocalcemia
3- wilson
4- diabetes

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What are the chromosomal abnormalities associated in Catarct

down

- patau

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What will you do if you see bilateral cataract

Intensive workup

TORCH screening
Syphilis (VDRL)
Calcium levels
Phosphorus
glactokinase
glucose
urine for reducing substance

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What will you see if you see unilateral cataract?

Bring them to OR immidiatly

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What does the management of cataract depen on?

The size - laterality

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How to treat cataract ( in general)

lensoctomy

- optical correction

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In small cataract what would you like to do next?

cover and Observe

However if i cover for long time i risk the development of ampylopia

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If the child is more than 1 year, what will we do in case of catarct?

Lens aspiration + IOL

“If less we don’t do IOL”

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If the child was less than 1 year of age, and we did not introdue IOL. what will we do

Provide a high power glassess

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To avoid formation of posterior membranes, what surgical intervention should we do in cataract

Posterior capsulotomy and anterior viterctomy

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What do you expect to see in glucoma?

megalocornea
Haabs striae
opacity and haze
corneal edema\scar

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What is the clinical presentation of primary congenital glucoma?

Epiphorea (tearing)
Blephrospasm (blinking)
Photophobia

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What is the IOP in glucoma?

>21mmhg increased

What causes opacity of the cornea?

Increased IOP will cause edema and it will go in the corena

What is the poor outcome of glucoma if IOP was not corrected in early childhood

Optic nerve damage leading to loss of sigth

What will you find in glucoma in fundoscopy examination

Cupping

When can we do surgery in glucoma

After 4-6 weeks of life, usually we do multiple

When is retinopathy of prematurity?

<31 weeks of gestation

What is the pathophysiology of ROP?

Cessation of vasculogensis after birth > VEGF release causing either - resuming normal process - abnormal proliferation leading to retinal detachment

What are the risk factors for ROP?

- LBW <1500 - <30 wks - Supplemental O2 - Coexisting illness rds-sepsis - Caucation - multiples

What;s the severist type of ROP

1 and 2 due to the closeness of optic nerve

Whats the treatment for ROP

1- observe 2- laser and cryotherapy 3- anti-VEGF 4- surgery if retinal detachment

Allergic conjunctivitis, bilateral or unilateral?

Bi-lateral because immune reaction

How does allergic conjunctivits present

Watery, itchy, puffy, history of atopy §

How to treat allergic conjunctivitis

- lubricant - cold compressor - Antihistamine - mast cell inhibitor

What reaction is seen with allrgic conjunctivits vs viral conjunctivits

Papillary reaction in allergic | Follicular in viral

How does viral conjunctivitis commonly present?

- History of contact - watery, itchy, puffy eyes “uni unless he scratch the other eye” - URTI hx

How should you treat viral conjunctivits?

Cold compressor and lubricant | Isolate from school for at least 7d

When to refer allergic and viral conjunctivits to optha

Allergic: one week Viral: 2 weeks

What are the risks for bacterial conjunctivitis

- Hygiene: Poor contact lens hygiene, contaminated cosmetics, elementary school, military - Ocular: dry eye, blepharitis, foreign body - Iatrogenic: recent surgery, chronic use of topical medication, immunocompromised

What diff bacterial conjunctivitis from viral and allergic

Mucopurulent discharge

Which age group is more common to develop bacterial conjunctivits?

Neonates from birth canal

How to approach newnate with bacterial conjunctivits

Scrape the discharge and put under gram stain, if gram negative diplococci > immidiatly treat w\IV AB

Is bacterial conjunctivtis uni or bilateral

Unilateral

Define opthalmia neonatorum

Neonatal conjunctivitis occuring within 30 days of life Caused by - chemical - nisseria - chlamydia - viral

Chemical opthalmia neonatorum starts at

24 hours of life

Nisseria opthalmia neonatroum starts at

3-5 days

Chlamydia opthlamia neonatrum starts at

5-14 fays

Viral opthalmia neonatorum starts at

After 2nd week

What chemical causes opthalmia neonatorum?

Silver nitrate

Differentiate between discharge in chlamydia and gonorrhea

Chlamedia minimal discharge | Gonorrhea copious diacharge

How to do prophylaxis of neonatorum opthalmia?

Erythromycin | Tetracyclin and iodine

How to treat opthalmia nenonatorum

Systemic AB

What aer the complications of opthalmia neonatorum

Sepsis Meningitis Pneumonia Blindness

What is the typical presentation of conginital nasolacrimal duct obstruction

1- tearing | 2- recurrent conjunctivitis

What should one rule out regarding tearing in congenital nasolacrimal duct obstruction?

Glcuoma

What is the pathophysiology of conginital nasolacrimal duct?

Obstruction at the valve of haner

How to treat congintial nasolacrimal duct obstruction?

- Spontanous (most common) - massage - topical AB in conjunctvitis - surgery in 1 year or older

What is the name of surgery in nasolacrimal duct obstruction?

Probing (metallic insstrument)

What are the types of cellulitis?

Pre-septal | Orbital

To differentiate treatment in cellulitis vs viral and allergic conjunctivitis

Cellulitis: hot compress Allergic: cold

What are the causes of preseptal cellulitis?

- Trauma “Staph” - URTI “ Strep, staph, Hib” - conjunctivits “impetigo, HSV”

How to treat preseptal?

Topical\systemic AB - self limited

Which type of cellulitis is more severe?and why

Orbital | It may cause blindness and meningitis

Orbital organism in <9yr: >9yr: Neonate: Old:

- single aerobic - complex aerobe + anaerobe - S.aureus & gram negative - s. Aureus, strep & anerobe

Treatment in orbital cellulitis differ from preseptal in that:

It requires admission, IV abx, imaging, neuro\ENT\ optha

What are the complications of orbital cellulitis

- Cavernous sinus thrombosis - Abscess - Endopthalmitis - Meningitis - Blindness

What are the things that you should preform to cautiously identify any red flag in orbital cellulitis

- Vitals & mental state: spread of infection - pupil reaction: infectious spreaded posteriorly - visual acuity: affected optic nerve - eye movement: affected muscle

What is the most important sign in orbital cellulitis?

Proptosis

How to differentiate orbital from preseptal cellulitis clinically

By the bulging of eye (proptosis) which is found in orbital cellulitis

What is a red flag in ptosis

3rd nerve palsy

What neurological disease may be associated with ptosis in newborn

Mysthenia gravis

Diurnal variation of ptosis and after exercise are associated with

Pupils assymetry + proptosis could give you a clue of

Horner’s syndrome

How to treat mild ptosis ?

Observation

If isolated ptosis is not corrected what could develop over the years

- astigmatism - occlusion amblyopia - head tilt “Chin up to see:

What do we call the ptosis found in marcus gunn jaw winking syndrom

Synkinetic ptosis

In marcus gunn jaw winking syndrome, what is the connection that causes the synketic ptosis?

Trigeminal V3 (external ptrygoid) + occlumotor (Superior vision) + levator palperbral superiorsis

The winking syndrome is commonly noticed during

breastfeeding or bottle feeding