Opthalmology Flashcards
What is leukocoria and what is indicative of?
Leukocoria is abscence of red reflex “becoming white”
Indicative of tumor (retinoblastoma)
What is the most common intraocular malginancy in children under the age 4
Retinoblastoma
What is the clinical presentation of retinoblastoma
- leukocoria
- strabismus
- poor vision
- red painful eye
- proptosis
What is the finding in the imaging for retinoblastoma?
Calcifications within tumor
What is the imaging modality of choice for retinoblastoma?
MRI brain and orbit
“Never CT”
What are the goals of RB therapy?
Preservation of
1- Life
2- Globe
3- sight
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
What is the follow up plan for retinoblastoma?
- Every 4-6w for EUA
- for RB1 genetic type
- systemic follow up for metastasis
In RB familial type, we should find
RB1 gene
Are the patients with sporadic RB have any genetic mutation
No
What is cataract
Opacification of lens
What is the most common inheretence of cataract in KSA
AR
What are the associated systemic disease in cataract?
1- galactosemia
2- hypoocalcemia
3- wilson
4- diabetes
What are the chromosomal abnormalities associated in Catarct
- down
- patau
What will you do if you see bilateral cataract
Intensive workup
- TORCH screening
- Syphilis (VDRL)
- Calcium levels
- Phosphorus
- glactokinase
- glucose
- urine for reducing substance
What will you see if you see unilateral cataract?
Bring them to OR immidiatly
What does the management of cataract depen on?
The size - laterality
How to treat cataract ( in general)
- lensoctomy
- optical correction
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
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”
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
To avoid formation of posterior membranes, what surgical intervention should we do in cataract
Posterior capsulotomy and anterior viterctomy
What do you expect to see in glucoma?
- megalocornea
- Haabs striae
- opacity and haze
- corneal edema\scar
What is the clinical presentation of primary congenital glucoma?
- Epiphorea (tearing)
- Blephrospasm (blinking)
- Photophobia
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
MG
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
