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Senoir 21-2 > Optho > Flashcards

Optho Flashcards

1
Q

What muscle closes the eyelid

A

Orbicularis oculi
—Closes the eyelid
—Innervated by CN VII (Facial)

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2
Q

What muscle opens the eyelid

A

Levator palpebrae superioris
—Opens the upper eyelid
—Innervated by CN III (Oculomotor)

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3
Q

What is mullers muscles

A

Mueller’s muscle
—Assists in opening the eyelids (upper/lower)
—Innervated by sympathetic ANS
(Widens palpebral fissure in situations associated with fear or surprise)

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4
Q

What are the three tunics of the eye

A

Fibrous tunic
Vascular tunic
Nervous tunic

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5
Q

What is the role of the cornea

A

Front window of the eye

The MAJOR REFRACTIVE surface of the eye (2/3 of the power)

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6
Q

What is the limbus

A

Where the sclera meets the cornea

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7
Q

What controls the opening and closing to the pupil

A

Sphincter – Parasympathetic ANS

Dilator – Sympathetic ANS

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8
Q

What is the palpabral conjunctiva

A

Covers the inside of the eyelids

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9
Q

What is the bulbar conjunctiva

A

Clear membrane that covers the sclera

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10
Q

What part of the eye produces aqueous humor

A

Ciliary Body

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11
Q

What is the function of the ciliary muscle

A

Contraction changes tension on zonular fibers

The fibers that suspend the lens
Allows focus on near objects

—Accommodation

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12
Q

What is the choroid

A

Vascular, pigmented layer

Between the sclera and the retina

Provides blood supply for the outer retinal layers

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13
Q

What is the space between the cornea and the iris

A

Anterior chamber

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14
Q

Where does the aqueous humor drain?

A

Anterior chamber

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15
Q

Where is the posterior chamber

A

Small space behind iris/in front of vitreous

Filled with aqueous humor

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16
Q

Describe the lens

A

Biconvex body

Suspended by zonules

Also has refractive responsibilities (1/3 of the power)

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17
Q

What is the neural lining of the eye

A

Retina

10 layers thick
Contains the Rods and Cons

Top 9 layers are transparent

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18
Q

What part of the eye is responsible for fine, central vision

A

Macula

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19
Q

What is the depression in the center of the fovea called

A

macula

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20
Q

How many nerves are contained in the macula

A

A third of all nerves

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21
Q

What’s the most important part of the retina

A

The macula

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22
Q

What is the location where the nerve fibers converge and the leave the eye

A

Optic disk

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23
Q

Where is the physiologic blind spot of the eye

A

15 degrees temporally

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24
Q

What are the 4 rectum muscles

A

Superior rectus
Inferior rectus
Medial rectus
Lateral rectus

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25
Q

What are the 2 oblique muscles of the eye

A

Superior oblique

Inferior oblique

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26
Q

What are the three layers of tears in the eye

A

Oil (outer layer)
—Meibomian Glands

Water (middle)
—Lacrimal
—Accessory Lacrimal

Mucin (inner layer)
—Goblet cells

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27
Q

What are the afferent and efferent pathway of the eye

A

Optic - Afferent pathway

Oculomotor + Parasympathetic - Efferent pathway

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28
Q

Watch this :

https://www.youtube.com/watch?v=WwB2jyj2lYM

A
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29
Q

What are Mydriatics

A

Meds for dilation = “Mydriatics”

Adrenergic-Stimulating
—Stimulate the pupillary dilator muscle

Cholinergic-Blocking
—Paralyzing the iris sphincter

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30
Q

What is a normal eye pressure range

A

10-21mmHG

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31
Q

Picked up slides at Lens and Vitreous D/o

A
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32
Q

Rheumatoid Arthirits is assoc with what other condition

A

Scleritis

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33
Q

What is the tissue with the highest protein content in the body

A

The lens

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34
Q

What are the three main layers of the Lens

A

Capsule
Cortex
Nucleus

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35
Q

What is the most common cause of cataracts

A

Age

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36
Q

Cataracts can be caused by IN steroids

A

Just a factoid

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37
Q

What is nuclear sclerosis

A

Yellow or brown discoloration of the nucleus

Blurs distance vision more than near vision

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38
Q

A pt presents with opacities near the posterior aspect of the lens
(Vacuoles/ Plaque like)

With a glare and difficulty reading

A

Posterior sub capsular

2/2 Young (less than 50) 
Ocular inflammation 
DM 
High NMyopia 
Ionizing rads 
Steroids 
Truama
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39
Q

Define Cortical Catarcts

A

Radial like spikes on a bike

Usually asymptomatic

Glare is more common complaint

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40
Q

a pt presents glare, monocular diplopia, fixed spots in the visual field, with decreased color perception

Think

A

Cataracts

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41
Q

What is the tx for catarcts

A

Early: Specactle prescription

If its small: dilation may improve Vision

Late: Surgical removal

42
Q

Does scopalamine help cataracts

A

Benefits are only temporary

43
Q

When is surgery indicated of catarcts

A

Glaucoma
Diabetic retinopathy
Age-related macular degeneration

44
Q

Is congenital cataracts recessive or dominant

A

Dominant

45
Q

What is Leukocoria

A

White pupil

46
Q

What is the tx for cataracts in children

A

Cataract is considered emergency

Brain learns to see with macula

First 3 to 4 months of life

Lost vision may be permanent

Need to prevent irreversible deprivational amblyopia

Refer to pediatrician to treat underlying disorders

47
Q

What is the difference between subluxation and dislocation of the lens

A

Subluxation
Partial disruption if the zonular fibers
—The lens is decentered!! but remains partially visible in the pupillary aperture

Dislocation
Complete disruption of the zonular fibers
-The lens is displaced out!! of the natural position in posterior chamber
ie. into vitreous or into anterior chamber

48
Q

What is the most common cause of Lens anomolies

A

Trauma

49
Q

What are two conditions associated with Lens position anomaly

A

Marfans and Homocystinuria

50
Q

What are the S/s of a Lens Position Anamoly

A 
Decreased vision
Monocular diplopia
Decentered or displaced lens
Quivering of the iris (iridodonesis)
Quivering of the lens (phacodonesis)
Marked irregular astigmatism
Angle-closure glaucoma
Cataract
Asymmetry of the anterior chamber
51
Q

Floaters and Flashes of acute onset indicate

A

Intermediate or posterior uveitis

Bleeding in the vitreous cavity

Diabetes

Sickle cell anemia

Posterior vitreous detachment

Retinal tear

Intraocular foreign body

52
Q

Flashes in the visual field indicate/ suggest

A

Suggests traction of the vitreous on the peripheral retina

  • Must rule out retinal detachment
  • R/o Posterior vitreous detachment

With floaters – blood/pigment in the vitreous

Also can occur with a migraine

  • Scintillations
  • Zig-Zag lights
53
Q

A pt presents with sudden appearance of balk spots/ flashing lights
With many floaters
And a vitreous opacity in the sharpe of a ring (Weiss ring) or partial ring.

Think

A

Vitreous Detachment

Tx with Referal

Photocoagulation/cryotherapy may be necessary if retinal break/tear/detachment occurs

54
Q

Where is the macula

A

5.5 mm in diameter centered on the fovea

55
Q

Where is the fovea

A

4 mm temporal/0.8 mm inferior to the optic nerve

Slightly darker and lacks vascularity

Has a Foveolar light reflex
-Small yellow reflex at center of fovea

56
Q

What are the two blood supplies to the eye

A

The central retinal artery
—Supplies the “inner retina” (towards inside of eye)

The choroid
—Supplies the “outer retina” (towards the outer wall)
—Supplies the photo receptors
—High oxygen demand

57
Q

What is the nerve fiber layer of the retina and the location of the ganglion nuclei

A

Inner retina

58
Q

What is the difference between Branch and Central artery occlusion of the retina

A

Central blocks out the entire vision

59
Q

Younger female with retinal artery occlusion

Think of what cause

A

Oral contraceptives

60
Q

A pt that loses vision in the eye suddenly that is now only light perceptive that happened upon rising in the morning

Think

A

Central retinal artery occlusion

61
Q

On fundascope you see whiting of the retina, with Gerry red spot in the center of the macula, with “box car” or segmentation in Arterioles

Think

A

Central renal artery occlusion

62
Q

How do we retinal artery occlusions

A

Immediate ESR, CRP, and platelets
—Rule out giant cell arteritis if over 55 years old

REFER!! Ocular massage and transport

High dose steroids for giant cell

63
Q

A pt presents with sudden, painless, unilateral vision loss

Look for

A

Central Retinal Vein or Artery occlusion

Vision will be more preserved with vein occlusion

64
Q

A pt presents with a blood and thunder fundus

Dot, blot, and flame-shaped hemorrhage
Cotton wool spots and exudates

Think ?.

A

Central retinal vein occlusion

65
Q

What is the tx for a Retinal Vein occlusion

A

Mandatory referal

D/C contraceptives
Reduce IOP

ANTI VEGF injections

With Aspirin once a day

66
Q

What are the two classifications of DM retinopathy

A

Non proliferative and proliferative

67
Q

How do we treat non prolif DM retinopathy

A

Tight BGL control

Referal
AntiVGEF injections
Or Pan retinal Photooag
Laser surgery

68
Q

What is rhegmatogenous

A

A break or tear in the retina truama usually

Fluid gets between the layers and detaches it

69
Q

What is a exudative retinal detachment

A

A leachage into the retina without a break

Typically for a tumor or source of fluid

70
Q

Flashes and floaters are only seen in what type of retinal detachment

A

Flashes and Floaters

71
Q

A pt presetns with flashes and floaters

Decreased Vision, like curtain pulled down

What kind or retinal detachment ?

A

Rhegmatogenous

72
Q

What is the approach to a retina detachment

A

Refer

Treatment
Rhegmatogenous
-Pneumatic retinopexy – intravitreal gas bubble with laser
-Scleral buckle – silicone belt around the outer globe

Tractional
-Pars plana vitrectomy

73
Q

What is the most common cute of blindness in pts over than 60 yo in the western world

A

Age related macular degeneration

74
Q

What is the most common abnormality of macular degeneration

A

Drusen

  • Foveal area (mild or extensive)
  • Yellowish deposits deep in the retina
  • Limits the nutritional support to outer retina (photoreceptors)
75
Q

What are the risk factors for Age Realted macular Degen

A

Cause typically unknown

Older age
Female gender
Lighter pigmentation
Smoking
Suspected genetic predisposition
76
Q

What is the differnce between wet and dry macular degen

A

DRY: Gradual loss of central vision
Clumps of pigment on outer retina

WET:
Distortion of straight lines
Rapid Central vision loss

+choroidal neovasc
+Subretinal Hemm.

77
Q

What are the risk factors that can turn dry AMD into wet AMD

A 
Advanced age
Hyperopia
Blue eyes
Family history
Larger, ill-defined drusen
Focal pigment clumps
Systemic hypertension
Smoking
78
Q

What is the W/u test for AMD

A

Ambler Grid

IV Flourescein angiography

Macular Slit lamp

And Family tracing

79
Q

How do you treat DRY AMD

A

High dose vitamin C, E, beta-carotene, and zinc (AREDS)
Reduces risk of progression by 25%

No beta-carotene for smokers (associated risk for lung cancer)

80
Q

What is the Tx for Wet AMD

A

Anti-vascular endothelial growth factor (Anti-VEGF) intravitreal injections

Laser photocoagulation
—Done within 72 hours of angiography

81
Q

What is the hallmark of HTN retinopathy

A

Hallmark = diffuse arteriolar narrowing

Blood vessel walls are virtually invisible

82
Q

A copper wire vessel or a yellowing of the linear light reflex

Is a sign of

A

HTN retinopathy

83
Q

Silver wire sign in the eye is a sign of

A

Sclerosis of the vessel

84
Q

What are the S/s of HTN retinopathy

A

Vision

  • May be normal
  • May be blurred slightly
  • May suddenly decrease

Blind spot in the vision (scotoma)

Double vision

85
Q

If you see a Star in the eye it is….. everytime…

A

HTN

86
Q

A pt presents with decreased vision, abnormal color vision, and difficulty adjusting to dark light

With a bulls eye maculopahty

What drug did they just start taking

A

Chloroquine

Send to Opto for baseline tests

87
Q

What is a NML IOP

A

10-21 is NML

88
Q

What are the two requirements for Glaucoma

A

Optic nerve damage and Visual Field loss

89
Q

What is the optic disc

A

Where optic nerve and blood vessels leave to globe

Anatomical blind spot

90
Q

How many visual field test do pts in the work up of glaucoma need

A

3

91
Q

What is the gold standard for tonometery of the eye

(Eye pressure)

A

Goldman Applanation

92
Q

What is the only thing that can be treated in glaucoma

A

Eye pressures ( tonometry)

93
Q

Is ocular HTN, glaucoma?

A

NO!!

Everything is normal except for the ocualr pressure

94
Q

What is the progression of Primary open Angle glaucoma

A

Rarely have any complaints in early disease
—Visual field defects must overlap

Decreased vision late in disease

  • Complaint of “parts of a page are missing”
  • Classic “tunnel vision” is a late complaint
  • Central fixation preserved until late
  • Remaining visual field - temporal island
95
Q

Demographics for Primary Open Angle Glaucoma

A

Fm HX
Age >50
African American or Hispanic

DM

HTN

96
Q

How do we treat open angle glaucoma

A

REFERAL!!

-

97
Q

What is the ADE of prostaglandin analogs for glaucoma

A

Conjunctival hyperemia

98
Q

What are the surgical options for Primary angle glaucoma

A

Trabeculoplasty

  • Argon laser
  • Selective laser

Trabeculectomy

  • Drainage implant (shunt) surgery
  • Aqueous flows into subconjunctival space (filtering bleb)

Ciliary body ablation
-Destroy a portion of the ciliary epithelium

99
Q

What are the S/s of acute angle closure glaucoma

A

Symptoms:
-Vision is blurred
—Typically in one eye

Monocular halos around lights

Intense ocular pain with photophobia

Frontal headache

Vasovagal symptoms

  • Nausea
  • Vomiting
100
Q

A pt presents with a mid dilated no reactive pupil
With conjunctival injections a
With absent light reflex with IOP 60-80

Think

A

Acute angle closure

101
Q

What is the treatment of choice for acute angle closure of the eye

A

Laser iridotomy

After the initial attack is broken

Senoir 21-2 (77 decks)

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