Opthalmology II

Question 1

Ddx of unilateral red eye

Answer 1

• viral or bacterial conjuctivitis
• iritis
• corneal abrasian
• corneal ulcer
• herpes simplex
• herpes zoster opthalmicus
• subconjuctival hemorrhage

Question 2

DDx of bilateral red eyes

Answer 2

• dry eyes
• allergic conjuctivitis

Question 3

Anatomic layers of cornea

Answer 3

• superficial to deep:
• epithelium
• bowman’s layer
• stroma
• descemet’s membrane
  
  • endothelium

Question 5

Indication for cataract surgey

Answer 5

• When patient’s quality of life is diminished: trouble reading, driving, watching TV, trouble with glare
• Newer surgeries not as “rough” for patients – patients can help decide when they are ready for surgery

Question 6

Indication for corneal transplant surgery

Answer 6

• Pseudokaphic or aphakik bullous keratopathy
• Endothelial dystrophy
• Keratoconus
• Trauma
• Regraft
• HSV/viral (2%)
• Corneal dystrophy
• Corneal degeneration
• Chemical injuries

Question 7

Basic step of cataract surgery

Answer 7

• Topical anesthesia
• Small incision (2.2 mm), circular tear made with laser
• The cataract inside the capsular bag is gently broken up with ultrasound and removed with a tiny vacuum
  
  • CAREFULLY AVOID tearing the capsule, one cell layer thick
• The IntraOcularLens is folded and inserted into the capsular bag, unfolds
• Put on bandage contact lens

Question 8

Sx and Dx: Blepharitis

Answer 8

• Inflammation of lid
• Crusting and symptoms worse in AM

Question 9

Tx: blepharitis

Answer 9

• Eye scrub
• baby shampoo
• bacitracin or erythromycin ointment

Question 10

Sx and Dx: Bacterial conjunctivitis

Answer 10

• Redness and mucopurulent discharge
• minimal discomfort
• vision minimally affected

Question 11

Tx: bacterial conjunctivitis

Answer 11

• Often will resolve without treatment
• Polytrim (antimicrobial ophthalmic solution)

Question 12

Sx and Dx: viral conjunctivitis (EKC)

Answer 12

• Pink eye.
• Photophobia, redness, watery discharge,
• bilateral but asymmetric (first eye is worst)
• preauricular lymphadenopathy
• Swollen follicles, white spots on cornea

Question 13

Tx: viral conjuctivitis

Answer 13

• Cool Compresses and artificial tears
• severe cases require topical steroid eye drops with pronounced inflammation
• Most cases are self-limiting within a week

Question 14

Sx and Dx: Allergic conjunctivitis

Answer 14

• seasonal onset
• bilateral
• Itch
• redness
• chemosis = conjuctival swelling
• mucopurulent discharge
• no pre-auricular node

Question 15

Tx: allergic conjunctivitis

Answer 15

• Avoidance therapy
• tears to flush antigen, cool compresses
• antihistamine + mast cell stabilizer
• Ointment of eye to lubricate cornea for chemosis.

Question 16

Sx and Dx: Orbital cellulitis

Answer 16

• Decreased vision
• proptosis
• abnormal pupillary response and motility
• disc swelling
• Dx: Blood culture, ENT consult

Question 17

Tx: orbital cellulitis

Answer 17

• systemic IV antibiotics/oral antibiotics
• prompt drainage of orbital/sinus abcess

Question 18

Sx and Dx/Tx: bacterial keratitis

Answer 18

• Trauma from contact lense wearers
• Sx:
  
  • pain, photophobia
  • decreased vision
  • white spot on cornea
• Tx:
  
  • 4th gen. fluoroquinolones as topical antibiotic tx

Question 19

Sx and Dx/Tx: HSV keratitis

Answer 19

• HSV: vesicles around eye
• Tx:
  
  • topical and oral antivirals
    
    • trifluridine
    • acyclovir
    • valtrex
    • famvir

Question 20

Sx and Dx: Narrow angle glaucoma

Answer 20

• Sudden onset of pain
• decreased vision
• nausea, vomiting
• haloes around lights
• pupil mid-dilated
• cornea is cloudy over time
• eye is very hard to the touch

Question 21

Tx: narrow angle glaucoma

Answer 21

• Treat right away
  
  • optic nerve does not tolerate rapid rise in pressure well
• β blocker, α agonist,
• Systemic carbonic anhydrase inhibitor and mannitol
• laser hole in iris