Opthalmology Reverse Cram Flashcards
How are lid lacerations Tx
When do these need to be referred to opthalmology for Tx?
Tetanus prophylaxis
PO ABX if contaminated/foreign body
Canalicular system involvement
Levator involved (ptosis)
Visible orbital fat= penetrated septum
More than 1/3 of lid tissue gone
When is a CT ordered for lid lacerations?
What else is done during a work up?
Globe involevement
Dilated exam
Canalicular/lacrimal exam
Lid function
Define Hyphema
What can cause these to spontaneously occur?
Blood collection in anterior chamber
Retinoblastoma
Leukemia
Clotting d/o
Child w/ spontaneous- abuse
What is the MC and other causes of hyphema?
African American PTs w/ hyphemas need to be screened for ?
Blunt trauma- MC
Neovascularization
Sickle Cell
How are hyphemas Tx
What needs to be avoided during Tx
Bed rest w/ head elevation
Shield eye w/ clear plastic/fox shield
Homatropine/Atropine/Scopalamine 2x/day
ASA
NSAIDs
What are the two types of blow out Fx
What will PT present complaining of after initial blunt trauma?
Direct- Fx of orbital rim extending posteriorly involving the floor
Indirect- compression of orbit soft tissue w/ no orbital rim involvement
Pain w/ movement
Binocular vision
What do PTs need to avoid after Dx of blow out Fx
What image is used for Dx and what image can not be used
Sneezing/blowing nose- communication between orbit/sinus
CT, not x-ray
How are blow out Fxs Tx
How doe intraocular foreign bodies present?
Refer/ice packs
Nasal decongestants x 3 days
Cephelexin
Peak pupil pointing to site of injury
What abnormal finding will be seen on PE of an intraocluar foreign body
How are these Tx
Red reflex where there shouldn’t be one
Shield eye
Vancomycin
Cycloplegics
Recommended surgical removal
Define Siderosis
What image is ordered for high speed injuries causing corneal foreign bodies?
Deposition of iron in tissue from long standing foreign body retention (intraocular)
CT scan
How are corneal foreign bodies Tx
What ABX are given post-tx?
Penetration- refer
Superficial- remove under topical anesthesia w/ saline irrigation, CTA and Jelewlers forceps
Polymyxin B/Trimeth/Fluroquinolone
How are chemical injuries in the eye Tx
What drug can be used to help with this process?
Irrigation x 30min
Wait 5-10min, check fornices pH w/ litmus paper
Continue irrigation until pH is neutral
Proparacaine
What meds are given for chemical burns after Tx?
What type of chemicals cause more severe burns?
Homatropine/Scopalamine
Erythromycin
Alkali- Lye Ammonia Lime Bleach
What can cause UV Keratitis
When are these conditions more severe?
Welding
Indoor tanning
Snow blindness
6-12hrs post-activity
How is UV keratitis Tx
PTs need to avoid contacts for ? long after removal for contact lens irritation Tx
Cyclopentaolate
Erythomycin ointment
Patch more affected eye
PO anesthetics
x14 days
If PT w/ contact lens irritation has abrasions, what meds are used?
What drugs are avoided in corneal abrasion?
Pseudomonas
Genta/Tobramycin and,
Cefazolin/Vancy
Alt drops of Gent/Vanc q30min
Topical anesthesia, melts cornea
How are corneal abrasions Tx
What Tx step is avoided if abrasion was from vegetative/finger nail/contact lens source?
Vegetative source: Fluoroquinolone
All others- Polymyxin B/Trimeth
Ciclopentaolate
Do not patch
Define Retinal Tumor
How do these present
Rare tumor of retina in PTs under 5y/o, usually 18mon
Leukoria
What other form of Ca presents as leukoria but is not a blastoma
What can cause orbital cellulitis
Astrocytoma- non-malignant tumor of CNS made of astrocytes
Hordeolum
Dacryocystitis
Trauma
How does orbital cellulitis present?
How are they Dx and Tx
Proptosis
Restricted ocular motility
CT of orbit, sinus and brain
Admit, broad sprectum ABX
How does preseptal cellulitis present?
What sing are absent and necessary for Dx
Tender red lid
Periorbital swelling
Mild fever
No Proptosis Restricted motility Pain w/ movement Neuropathy
What ABX is used for mild preseptal cellulitis
When do these PTs need to be admitted
What ABX are used inpatient?
Amox/Clavu
Toxic
<5y/o
Noncompliant
No improvement after 48hrs
Vanc and Ceftriax
Define Amaurosis Fugax
What type of plaque may be seen on PE exam?
Loss of vision in one eye from TIA w/ spontaneous resolution
Hollenhorst
How does a CN3 palsy present, causes and work up
Ptosis/HA
Eye down/out
Vascular/Compression
MRI stat if pupil dilated
Cerebral angiography
Observe and eval if pupil spared
How does a CN4 palsy present, causes and work up
Vertical/oblique diplopia
Objects appear tilted, PT may tilt head
Idiopathic Trauma Tumor Vascular
MRI if:
<45
45-55 no RFs or more than one CN involved
How does a CN6 palsy present, causes and work up
Horizontal diplopia
HA
Esotropia
Adopted head turn
Tumor Idiopathic Cavernous sinus dz
Tumor Vascular
MRI if w/out vascular RFs
Optic neuritis
<50y/o Female w/ frontal HA
VA 20/200 or better
Central scotoma MC defect
Pain w/ movement
NAION
> 50y/o PT w/ sudden unilateral vision loss upon waking
VA 20/400 or better
Inferior altitudinal defect
No pain
AAION
> 60y/o female w/ HA and scalp/jaw tenderness
VA 20/400 w/ inferior altitudinal defect
Painful
What is usually the first sing of Multiple Sclerosis?
Demyelinating optic neuritis
