Optho Flashcards
1
Q
What muscle closes the eyelid
A
Orbicularis oculi
—Closes the eyelid
—Innervated by CN VII (Facial)
2
Q
What muscle opens the eyelid
A
Levator palpebrae superioris
—Opens the upper eyelid
—Innervated by CN III (Oculomotor)
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)
4
Q
What are the three tunics of the eye
A
Fibrous tunic
Vascular tunic
Nervous tunic
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)
6
Q
What is the limbus
A
Where the sclera meets the cornea
7
Q
What controls the opening and closing to the pupil
A
Sphincter – Parasympathetic ANS
Dilator – Sympathetic ANS
8
Q
What is the palpabral conjunctiva
A
Covers the inside of the eyelids
9
Q
What is the bulbar conjunctiva
A
Clear membrane that covers the sclera
10
Q
What part of the eye produces aqueous humor
A
Ciliary Body
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
12
Q
What is the choroid
A
Vascular, pigmented layer
Between the sclera and the retina
Provides blood supply for the outer retinal layers
13
Q
What is the space between the cornea and the iris
A
Anterior chamber
14
Q
Where does the aqueous humor drain?
A
Anterior chamber
15
Q
Where is the posterior chamber
A
Small space behind iris/in front of vitreous
Filled with aqueous humor
16
Q
Describe the lens
A
Biconvex body
Suspended by zonules
Also has refractive responsibilities (1/3 of the power)
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
18
Q
What part of the eye is responsible for fine, central vision
A
Macula
19
Q
What is the depression in the center of the fovea called
A
macula
20
Q
How many nerves are contained in the macula
A
A third of all nerves
21
Q
What’s the most important part of the retina
A
The macula
22
Q
What is the location where the nerve fibers converge and the leave the eye
A
Optic disk
23
Q
Where is the physiologic blind spot of the eye
A
15 degrees temporally
24
Q
What are the 4 rectum muscles
A
Superior rectus
Inferior rectus
Medial rectus
Lateral rectus
25
What are the 2 oblique muscles of the eye
Superior oblique
| Inferior oblique
26
What are the three layers of tears in the eye
Oil (outer layer)
—Meibomian Glands
Water (middle)
—Lacrimal
—Accessory Lacrimal
Mucin (inner layer)
—Goblet cells
27
What are the afferent and efferent pathway of the eye
Optic - Afferent pathway
Oculomotor + Parasympathetic - Efferent pathway
28
Watch this :
https://www.youtube.com/watch?v=WwB2jyj2lYM
29
What are Mydriatics
Meds for dilation = “Mydriatics”
Adrenergic-Stimulating
—Stimulate the pupillary dilator muscle
Cholinergic-Blocking
—Paralyzing the iris sphincter
30
What is a normal eye pressure range
10-21mmHG
31
Picked up slides at Lens and Vitreous D/o
32
Rheumatoid Arthirits is assoc with what other condition
Scleritis
33
What is the tissue with the highest protein content in the body
The lens
34
What are the three main layers of the Lens
Capsule
Cortex
Nucleus
35
What is the most common cause of cataracts
Age
36
Cataracts can be caused by IN steroids
Just a factoid
37
What is nuclear sclerosis
Yellow or brown discoloration of the nucleus
Blurs distance vision more than near vision
38
A pt presents with opacities near the posterior aspect of the lens
(Vacuoles/ Plaque like)
With a glare and difficulty reading
Posterior sub capsular
```
2/2 Young (less than 50)
Ocular inflammation
DM
High NMyopia
Ionizing rads
Steroids
Truama
```
39
Define Cortical Catarcts
Radial like spikes on a bike
Usually asymptomatic
Glare is more common complaint
40
a pt presents glare, monocular diplopia, fixed spots in the visual field, with decreased color perception
Think
Cataracts
41
What is the tx for catarcts
Early: Specactle prescription
If its small: dilation may improve Vision
Late: Surgical removal
42
Does scopalamine help cataracts
Benefits are only temporary
43
When is surgery indicated of catarcts
Glaucoma
Diabetic retinopathy
Age-related macular degeneration
44
Is congenital cataracts recessive or dominant
Dominant
45
What is Leukocoria
White pupil
46
What is the tx for cataracts in children
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
What is the difference between subluxation and dislocation of the lens
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
What is the most common cause of Lens anomolies
Trauma
49
What are two conditions associated with Lens position anomaly
Marfans and Homocystinuria
50
What are the S/s of a Lens Position Anamoly
```
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
Floaters and Flashes of acute onset indicate
Intermediate or posterior uveitis
Bleeding in the vitreous cavity
Diabetes
Sickle cell anemia
Posterior vitreous detachment
Retinal tear
Intraocular foreign body
52
Flashes in the visual field indicate/ suggest
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
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
Vitreous Detachment
Tx with Referal
Photocoagulation/cryotherapy may be necessary if retinal break/tear/detachment occurs
54
Where is the macula
5.5 mm in diameter centered on the fovea
55
Where is the fovea
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
What are the two blood supplies to the eye
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
What is the nerve fiber layer of the retina and the location of the ganglion nuclei
Inner retina
58
What is the difference between Branch and Central artery occlusion of the retina
Central blocks out the entire vision
59
Younger female with retinal artery occlusion
Think of what cause
Oral contraceptives
60
A pt that loses vision in the eye suddenly that is now only light perceptive that happened upon rising in the morning
Think
Central retinal artery occlusion
61
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
Central renal artery occlusion
62
How do we retinal artery occlusions
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
A pt presents with sudden, painless, unilateral vision loss
Look for
Central Retinal Vein or Artery occlusion
Vision will be more preserved with vein occlusion
64
A pt presents with a blood and thunder fundus
Dot, blot, and flame-shaped hemorrhage
Cotton wool spots and exudates
Think ?.
Central retinal vein occlusion
65
What is the tx for a Retinal Vein occlusion
Mandatory referal
D/C contraceptives
Reduce IOP
ANTI VEGF injections
With Aspirin once a day
66
What are the two classifications of DM retinopathy
Non proliferative and proliferative
67
How do we treat non prolif DM retinopathy
Tight BGL control
| Referal
AntiVGEF injections
Or Pan retinal Photooag
Laser surgery
68
What is rhegmatogenous
A break or tear in the retina truama usually
Fluid gets between the layers and detaches it
69
What is a exudative retinal detachment
A leachage into the retina without a break
Typically for a tumor or source of fluid
70
Flashes and floaters are only seen in what type of retinal detachment
Flashes and Floaters
71
A pt presetns with flashes and floaters
Decreased Vision, like curtain pulled down
What kind or retinal detachment ?
Rhegmatogenous
72
What is the approach to a retina detachment
Refer
Treatment
Rhegmatogenous
-Pneumatic retinopexy – intravitreal gas bubble with laser
-Scleral buckle – silicone belt around the outer globe
Tractional
-Pars plana vitrectomy
73
What is the most common cute of blindness in pts over than 60 yo in the western world
Age related macular degeneration
74
What is the most common abnormality of macular degeneration
Drusen
- Foveal area (mild or extensive)
- Yellowish deposits deep in the retina
- Limits the nutritional support to outer retina (photoreceptors)
75
What are the risk factors for Age Realted macular Degen
Cause typically unknown
```
Older age
Female gender
Lighter pigmentation
Smoking
Suspected genetic predisposition
```
76
What is the differnce between wet and dry macular degen
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
What are the risk factors that can turn dry AMD into wet AMD
```
Advanced age
Hyperopia
Blue eyes
Family history
Larger, ill-defined drusen
Focal pigment clumps
Systemic hypertension
Smoking
```
78
What is the W/u test for AMD
Ambler Grid
IV Flourescein angiography
Macular Slit lamp
And Family tracing
79
How do you treat DRY AMD
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
What is the Tx for Wet AMD
Anti-vascular endothelial growth factor (Anti-VEGF) intravitreal injections
Laser photocoagulation
—Done within 72 hours of angiography
81
What is the hallmark of HTN retinopathy
Hallmark = diffuse arteriolar narrowing
Blood vessel walls are virtually invisible
82
A copper wire vessel or a yellowing of the linear light reflex
Is a sign of
HTN retinopathy
83
Silver wire sign in the eye is a sign of
Sclerosis of the vessel
84
What are the S/s of HTN retinopathy
Vision
- May be normal
- May be blurred slightly
- May suddenly decrease
Blind spot in the vision (scotoma)
Double vision
85
If you see a Star in the eye it is….. everytime…
HTN
86
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
Chloroquine
Send to Opto for baseline tests
87
What is a NML IOP
10-21 is NML
88
What are the two requirements for Glaucoma
Optic nerve damage and Visual Field loss
89
What is the optic disc
Where optic nerve and blood vessels leave to globe
Anatomical blind spot
90
How many visual field test do pts in the work up of glaucoma need
3
91
What is the gold standard for tonometery of the eye
| (Eye pressure)
Goldman Applanation
92
What is the only thing that can be treated in glaucoma
Eye pressures ( tonometry)
93
Is ocular HTN, glaucoma?
NO!!
Everything is normal except for the ocualr pressure
94
What is the progression of Primary open Angle glaucoma
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
Demographics for Primary Open Angle Glaucoma
Fm HX
Age >50
African American or Hispanic
DM
HTN
96
How do we treat open angle glaucoma
REFERAL!!
-
97
What is the ADE of prostaglandin analogs for glaucoma
Conjunctival hyperemia
98
What are the surgical options for Primary angle glaucoma
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
What are the S/s of acute angle closure glaucoma
Symptoms:
-Vision is blurred
—Typically in one eye
Monocular halos around lights
Intense ocular pain with photophobia
Frontal headache
Vasovagal symptoms
- Nausea
- Vomiting
100
A pt presents with a mid dilated no reactive pupil
With conjunctival injections a
With absent light reflex with IOP 60-80
Think
Acute angle closure
101
What is the treatment of choice for acute angle closure of the eye
Laser iridotomy
| After the initial attack is broken
