Optho Flashcards
ambylopia
unilateral or bilateral loss of vision not structural of visual, due to brain suppressing signal from eye due to strabismus or visual deprivation.
estropia
inward deviation of eyes compared to normal
exotropia
outward deviation of eyes when compared with normal
strabismus
misalignment of eye, examples include esotropia, exotropia, hypertropia (1 eye deviated up). Can be neurogenic, muscular, or congenital.
RAPD- relative afferent pupillary defect
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).
Congenital Esotropia
presents by age of 6, rarely present at birth.
Accomodative esotropia
most common esotropia in childhood, developed between 6 months to 7 yrs, improves when vision is corrected.
pseudoesotropia
common in infants due to anatomy, shine light in eyes and it will light in similar areas of the eye.
6th nerve palsy
Not able to use LR muscle causing limited abduction on affected eye, this is 1st cranial nerve to go with increased intracranial pressure.
Unexplained new onset strabismus, what to do?
Mandates further eval with neuroimaging, think tumor, intracranial hemorrhage, botulism, lead poisoning, etc.
Retinal Artery Occlusion
Painless, associated with RAPD relative afferent pupillary defect.
mydriasis
dilation of pupil
Acute Angle Closure Glaucoma
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.
Treatment of acute angle closure glaucoma
Can use topical bb or acetazolimide, brimonidine, and glycerin, ultimately laser peripheral iridotomy. NEVER USE ATROPINE!
MOA of topical BB and Carbonic Anhydrase inhibitors
reduce aqueous production leading to decreased intraocular pressure
MOA topical alpha-adrenergicagonists
brimonodine lowers intraocular pressure
Topical Glycerin
Helps reduce corneal edema
RF for getting open angle glaucoma
fam hx, high intraocular pressure, thin corneas, minor rf are diabetes and myopia (near sightedness)
Diagnosing open angle glaucoma
may see cupping of optic nerve head with corresponding visual field defect, if no cupping then considered ocular hypertension.
Optic Neuritis
painless, young patients, sectorial loss of vision, central scotoma (blind spot).
AMD- Age related macular degeneration
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
Dry AMD
nonneovascular with drusen (yellow lesions on outer retinal layers of macula) or atrophy within macula
Wet AMD
Neovascular AMD a/w choroidal neovasclar membrane, it can grown into the macula or fovea and affect vision.
Findings in nonproliferative diabetic retinopathy
exudates, cotton wool spots, dot-blot heorrhages, microaneurysms
What causes vision loss in nonproliferative DR
Macular edema, can use focal laser for treatment on affected areas.
Vision loss in proliferate DR
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.
Tx of proliferative DR
Panretinal photocoagulation
Complications of Hyphema
rebleeding (most common within 3-5 d), corneal staining, and glaucoma
Dx and Tx of Hyphema
usually traumatic, blood in anterior chamber, r/o ruptured globe. Tx with topical steroids
What foreign bodies must be removed
iron, copper, aluminum, can leave glass
Signs of retained iron in eye
iris heterochromia, mydriasis, glaucoma, retinal degeneration.
Viral conjunctivitis
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.
Gonococcal conjunctivitis
Severe purulent discharge w/in 12-24 hrs of infection, may have preauricular adenopathy. Send culture, IM CTX+aZITHRO, eye irrigation, treat for chlamydia
Allergic Conjunctivitis
cool compresses, artificial tears, benadryl, topical steroids only for extreme cases, ok to use short-term topical anti-histamines like olopatadine or levocabastine,
Tx of corneal abrasion
If not a contact wearer, observation ok but can use erythro or sulfacetamide if concerned. If wears contacts then use abx (fluoroquinolone).
Iritis
inflammation of the iris, can see “ciliary flush” or a red ring around the iris, can be posttraumatic, ra, ankylosing spondylitis, syphillis, tb, sarcoid.
Meibomian Gland Dysfunction
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
meibomian gland dysfunction treatment
daily warm compresses, lid scrubs with dilute baby shampoo, and oral doxy or flagyl. Ca lead to chalazions.
preseptal cellulitis
infection of anterior chamber of septum, red and painful over eyelids. Staph aureus most common cause.
orbital cellulitis
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.
Retinal Artery Occlusion
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.
Retinal detachment
flashing lights, floaters, visual field disruption, rf are trauma and previous surgery, >50, myopia, aphakia
Cataracts- rf, sx, tx
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.
