optho

Question 1

Neonate has unilateral painless excessive tearing and discharge

Answer 1

Blocked tear duct (dacryostenosis)

Tx - nasolacrimal massage up until 1 year. If persistant >1yr nasal duct probe

Question 2

Tx for viral conjunctivitis

Answer 2

None is necessary, just good hygiene

Question 3

5 day old baby w/ b/l conjunctivitis and purulent discharge

Answer 3

Gonococcal ophtalmia
Tx - systemic ceftriaxone (already failed topical erythromycin)
If left untreated -> blindness

Question 4

Febrile pt is unable to look down and out, pupils are dilated and fixed. Why?

Answer 4

Oribtal cellulitis
Complication of sinusitis, eyelid trauma, dental/oral infections
Can lead to permanent vision loss, meningitis, and cavernous sinus thrombosis
Tx - IV or po abx

Question 5

Pt with vision loss on retinal exam the neurosensory retina is separating from the retinal pigment epithelium. Abn growth of the choroidal vessels

Answer 5

Wet Macular degeneration

Tx- Laser photocoagulation of the subretinal neovascular membranes may delay onset of permanent vision loss

Question 6

After prolonged contact wear (days) pt presents with a corneal ulcer. Tx?

Answer 6

Scrape the ulcer for Gram stain and culture to evaluate for sensitivities prior to starting a abx

Question 7

Eyelid nodule that is firm painless indurated w/ loss of lashes and a yellowish lid

Answer 7

Suspicious for sebaceous cell carcinoma. Get a bx

Upper lid of a femal >50

Question 8

Trisomy 21 baby has a pupil that turns inward on lateral gaze and corneal light reflex is symmetric

Answer 8

Pseudostrabismus
Common in Trisomy 21, reassure that the child is normal
if corneal reflex is ASYMMETRIC -> true strabismus

Question 9

Unilateral eye pain, red eye on CT - retrobulbar fat-stranding and inflammation

Answer 9

Orbital inflammatory pseudotumor
Idiopathic
Tx - corticosteroids

Question 10

Blowout fx of the optic orbit

Answer 10

Ophthalmologic emergency

Can cause inferior rectus entrapment and enophthalmos

Question 11

Flame shaped hemorrhages and multiple cotton wool spots

Answer 11

Hypertensive retinopathy

Question 12

Pt has chemosis, large cobblestone-appearing papillae, lymphoid follicles at the limbus. Dx and Tx?

Answer 12

Allergic conjunctivitis
Acute - OTC antihistamine
Subacute (more than 2 episodes/month) - top ketotifen

Question 13

Crohn’s pt with unilateral eye pain, photophobia, decreased vision in affected eye

Answer 13

Suspect anterior nongranulomatous uveitis

Exam - small keratic preceipitates on the corneal epithelium

Question 14

DM pt w/ retina with cotton-wool spots and hard exudates

Answer 14

Nonproliferative retinopathy

Tx - Laser photocoagulation

Question 15

Pt has a wedge shaped growth of superficial tissue growing over the right eye

Answer 15

Pterygium
Benign growth of vascularized conjunctiva extending onto the cornea
Occurs in pts repeatedly subjected to conjunctival irritation (wind, sun, dust)
Tx - surgical removal

Question 16

Pt taking orlistat develops night blindness. Why?

Answer 16

Deficiency of fat soluble vitamins (vit A)

Question 17

Glaucoma with a steamy cornea

Answer 17

Anterior uveitis with secondary acute angle closure

Question 18

Infant has newly developed unilateral white reflex. Now what?

Answer 18

Get an emergent opthalmologic consult
New leukocoria
Suspicious for retinoblastoma

Question 19

How frequently should a person be screened for glaucoma?

Answer 19

Annually if >40 and RF’s present (elevated IOP, black, FHx, DM)

Question 20

AIDS pt has c/o clear floaters in her eyes and flashy lights

Answer 20

Be concerned for CMV retinitis
Causes retinal edema and necrosis
Scotoma = floaters
Photopsia = flashing lights

Question 21

Following URI pt has unilateral conjunctivits. Most likely cause?

Answer 21

Adenovirus

Question 22

On slit lamp, part of the retina is opaque

Answer 22

Be suspicious for a cataract. Mature cataract would occlude the entire retina
Follow this patient closely

Question 23

Proptosis + HA + blurry vision. CT reveals mass in the lacrimal gland

Answer 23

Adenocarcinoma of the lacrimal gland

Question 24

Acute angle-closure glaucoma occurs due to lesion in the?

Answer 24

Iris
Trabecular mesh becomes blocked
Tx - iridotomy

Question 25

Conjunctivitis pt has whitish eye discharge. Tx w/?

Answer 25

Sulfa ophtahalmic drops
Staph, Strep, H. flu, pseudomonas, Moraxella
Viral discharge is more watery

Question 26

Pt suspicious for corneal abrasion but cannot do a good exam

Answer 26

Top tetracaine (anesthetic)
Helps to allow for an adequate fundoscopy and fluorescin slit lamp

Question 27

Days after a cataract surgery pt presents with swollen eyelid, edematous conjunctiva, exudates in anterior chamber, and decreased visual acuity

Answer 27

Postop endophthalmitis
Usually occurs w/in six weeks of surgery
Infection of the eye, particularly the vitreous
Tx- abx or vitrectomy

Question 28

Fundoscopy = cupping of the optic disc

Constricted peripheral vision

Answer 28

Primary open angle glaucoma
More common in AA
Tunnel vision over a period of years

Question 29

Conact wearer presents with painful red eye, opacification and ulcertion of the cornea

Answer 29

Contact lens keratitis
Most common cause (pseudomonas)
Medical emergency - remove lens and bbroad spectrum abx

Question 30

Presbyopia

Answer 30

Loss of near vision due to decreased lens elasticity

Question 31

What meds should be avoided in a pt with acute glaucoma?

Answer 31

mydriatic agents (atropine)
Causes the eye to dilate

Question 32

What is useful in tx acute angle glaucoma?

Answer 32

Narcotics

Mannitol, acetazolamide, timolol, pilocarpine

Question 33

After loss of vision in one eye due to a penetrating injury, the other eye has floaters and blurred vision

Answer 33

Sympathetic ophtalmia

Uncovers hidden antigents

Question 34

Emergent tx of retinal a. occlusion

Answer 34

Ocular massage and high flow oxygen