Optho

Question 1

ambylopia

Answer 1

unilateral or bilateral loss of vision not structural of visual, due to brain suppressing signal from eye due to strabismus or visual deprivation.

Question 2

estropia

Answer 2

inward deviation of eyes compared to normal

Question 3

exotropia

Answer 3

outward deviation of eyes when compared with normal

Question 4

strabismus

Answer 4

misalignment of eye, examples include esotropia, exotropia, hypertropia (1 eye deviated up). Can be neurogenic, muscular, or congenital.

Question 5

RAPD- relative afferent pupillary defect

Answer 5

eye with RAPD will dilate with direct light but appropriately constrict with light directed at good eye, caused by optic nerve injury or retinal disease (optic neuritis, RA occlusion, retinal detachment).

Question 6

Congenital Esotropia

Answer 6

presents by age of 6, rarely present at birth.

Question 7

Accomodative esotropia

Answer 7

most common esotropia in childhood, developed between 6 months to 7 yrs, improves when vision is corrected.

Question 8

pseudoesotropia

Answer 8

common in infants due to anatomy, shine light in eyes and it will light in similar areas of the eye.

Question 9

6th nerve palsy

Answer 9

Not able to use LR muscle causing limited abduction on affected eye, this is 1st cranial nerve to go with increased intracranial pressure.

Question 10

Unexplained new onset strabismus, what to do?

Answer 10

Mandates further eval with neuroimaging, think tumor, intracranial hemorrhage, botulism, lead poisoning, etc.

Question 11

Retinal Artery Occlusion

Answer 11

Painless, associated with RAPD relative afferent pupillary defect.

Question 12

mydriasis

Answer 12

dilation of pupil

Question 13

Acute Angle Closure Glaucoma

Answer 13

need intraocular pressure measurement to diagnose, rf are hyperopia (farsightedness), asian, female, older. Can present with headache, vomiting, abd pain, halos around light, eye pain, blurred vision.

Question 14

Treatment of acute angle closure glaucoma

Answer 14

Can use topical bb or acetazolimide, brimonidine, and glycerin, ultimately laser peripheral iridotomy. NEVER USE ATROPINE!

Question 15

MOA of topical BB and Carbonic Anhydrase inhibitors

Answer 15

reduce aqueous production leading to decreased intraocular pressure

Question 16

MOA topical alpha-adrenergicagonists

Answer 16

brimonodine lowers intraocular pressure

Question 17

Topical Glycerin

Answer 17

Helps reduce corneal edema

Question 18

RF for getting open angle glaucoma

Answer 18

fam hx, high intraocular pressure, thin corneas, minor rf are diabetes and myopia (near sightedness)

Question 19

Diagnosing open angle glaucoma

Answer 19

may see cupping of optic nerve head with corresponding visual field defect, if no cupping then considered ocular hypertension.

Question 20

Optic Neuritis

Answer 20

painless, young patients, sectorial loss of vision, central scotoma (blind spot).

Question 21

AMD- Age related macular degeneration

Answer 21

leading cause of severe central vision loss in pts >50, rf caucasian, smoking a/w progression. complain of distortion and/or waviness in central visual field

Question 22

Dry AMD

Answer 22

nonneovascular with drusen (yellow lesions on outer retinal layers of macula) or atrophy within macula

Question 23

Wet AMD

Answer 23

Neovascular AMD a/w choroidal neovasclar membrane, it can grown into the macula or fovea and affect vision.

Question 24

Findings in nonproliferative diabetic retinopathy

Answer 24

exudates, cotton wool spots, dot-blot heorrhages, microaneurysms

Question 25

What causes vision loss in nonproliferative DR

Answer 25

Macular edema, can use focal laser for treatment on affected areas.

Question 26

Vision loss in proliferate DR

Answer 26

vitreous hemorrhages caused by friable neovascular vessels that break open and bleed. Can also cause vision loss if vessels grow over drainage of the eye, causing glaucoma.

Question 27

Tx of proliferative DR

Answer 27

Panretinal photocoagulation

Question 28

Complications of Hyphema

Answer 28

rebleeding (most common within 3-5 d), corneal staining, and glaucoma

Question 29

Dx and Tx of Hyphema

Answer 29

usually traumatic, blood in anterior chamber, r/o ruptured globe. Tx with topical steroids

Question 30

What foreign bodies must be removed

Answer 30

iron, copper, aluminum, can leave glass

Question 31

Signs of retained iron in eye

Answer 31

iris heterochromia, mydriasis, glaucoma, retinal degeneration.

Question 32

Viral conjunctivitis

Answer 32

1 eye then the other, preauricular node, cool compresses, hygiene, artificial tears 4-8 times daily. Contagious as long as eye is red and producing discharge.

Question 33

Gonococcal conjunctivitis

Answer 33

Severe purulent discharge w/in 12-24 hrs of infection, may have preauricular adenopathy. Send culture, IM CTX+aZITHRO, eye irrigation, treat for chlamydia

Question 34

Allergic Conjunctivitis

Answer 34

cool compresses, artificial tears, benadryl, topical steroids only for extreme cases, ok to use short-term topical anti-histamines like olopatadine or levocabastine,

Question 35

Tx of corneal abrasion

Answer 35

If not a contact wearer, observation ok but can use erythro or sulfacetamide if concerned. If wears contacts then use abx (fluoroquinolone).

Question 36

Iritis

Answer 36

inflammation of the iris, can see “ciliary flush” or a red ring around the iris, can be posttraumatic, ra, ankylosing spondylitis, syphillis, tb, sarcoid.

Question 37

Meibomian Gland Dysfunction

Answer 37

involves posterior lid margins behind the lashes, punctate openings along lid margin become inspissated with thick secretions. A/w rosacea, causes redness, burning, filmy vision, foreign body sensation

Question 38

meibomian gland dysfunction treatment

Answer 38

daily warm compresses, lid scrubs with dilute baby shampoo, and oral doxy or flagyl. Ca lead to chalazions.

Question 39

preseptal cellulitis

Answer 39

infection of anterior chamber of septum, red and painful over eyelids. Staph aureus most common cause.

Question 40

orbital cellulitis

Answer 40

more serious, can cause deep tissue infection, usually polymicrobial, compartment syndrome, affects vision, motion, and chemosis. Complications of cavernous sinus thrombosis, meningitis, or intracranial abscess.

Question 41

Retinal Artery Occlusion

Answer 41

sudden, painless loss of vision in pt with cardiac disease. Pale fundus, RAPD, reddish hue in macula. Need intervention within 90 m to save vision, digital decompression, o2, acetazolomide. think GCA.

Question 42

Retinal detachment

Answer 42

flashing lights, floaters, visual field disruption, rf are trauma and previous surgery, >50, myopia, aphakia

Question 43

Cataracts- rf, sx, tx

Answer 43

rf age, tobacco, etoh, sunlight, dm, steroids, trauma, radiation. Progressive visual liss and glare while driving at night, diminished red reflex, haze of gray over lens.