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Opthalmology > Optho ALL > Flashcards

Optho ALL Flashcards

1
Q

What 3 things can cause sudden vision loss

A
  1. central retinal artery occlusion
  2. Anterior ischemic optic neuropathy/papillitis/papilledema
  3. retinal detachment
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2
Q

What 3 things cause chronic vision loss

A
  1. Senile Cataract
  2. Primary open angle glaucoma (glacomatous cupping)
  3. age related macular degeneration (wet/dry)
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3
Q

what 3 things are associated with trauma

A
  1. sub-conjunctival hemorrhage
  2. orbit trauma / blowout fracture
  3. hyphema
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4
Q

what is on differential for red eye

A
  1. subconjunctival hemorrhage
  2. follicular conjunictivits (viral and allergic)
  3. hordeolum / chalaion
  4. blepharitis
  5. HSV keratitis
  6. Bacterial keratitis / hypopyon
  7. iritis
  8. Angle closure glaucoma
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5
Q

What 2 common peds issues are encountered?

A

esotropia, amblyopia

leukocoria

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6
Q

what 2 neuro things have optho findings?

A
  1. CN III, VI palsies

2. horners

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7
Q

What are 4 systemic diseases that appear in the eye

A
  1. diabetic retinopathy (preproliferative/neovascular)
  2. Herpes Zoster opthalmicus
  3. orbital cellulitis
  4. Graaves orbitopathy
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8
Q

Visual acuity testing

A

goal is to document best possible vision in each eye wearing glasses

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9
Q

when do you have problems night driving

A

20/40

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10
Q

when do you have problems day driving and need to read newspaper with magnifier

A

20/70

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11
Q

When are you legally blind (stil able to care for self)

A

20/200

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12
Q

When is ambulation impaired (need dog and stick)

A

finger count of 4

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13
Q

how much of the disk should the cup be

A

no more than 30-40% of the disk

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14
Q

Retinal artery occlusion presentation

A

painless acute vision loss. “like a dark curtain coming down.” Relative pupillary defect

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15
Q

Retinal artery occlusion physical

A

cherry red spot on the macula, vessels are attenuated and have box car appearance

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16
Q

Where does CRAO come from?

A

GCA or embolic stroke. be careful of embolic or thrombotic events

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17
Q

tx of CRAO

A

no treatment to recover vision. Opthalmologist may advise pressure lowering

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18
Q

Retinal detachment presentation

A

rapid vision loss in 1 eye with dark spots, flashers, floaters. Vision like a dark curtain creeping towards the center

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19
Q

Retinal dechment physical

A

retina will appear detached with loss of vessels and grayish color (maybe corrugated)

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20
Q

retinal detachment urgency

A

emergent if fovea not involved. If central acuity is lost, you can do repair within the week although sight will not be fully resotred

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21
Q

retinal detachment tx

A

LASER barricade to pin it down

scleral buckle, vitrectomy

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22
Q

where does retinal detachment come from

A

vitreous traction on the retina allowing fluid to move underneath and lift the retina

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23
Q

arteritic anterior ischemic optic neuropathy presentation

A

vision loss, GCA sx of claudication.

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24
Q

arteritic anterior ischemic optic neuropathy physical

A

fundus has a chalky white appearance (pale, swollen nerve). High ESR, CRP, CBC

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25
Q

arteritic anterior ischemic optic neuropathy urgency

A

EMERGENCY

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26
Q

arteritic anterior ischemic optic neuropathy tx

A

start high dose steroids for GCA. temporal artery biopsy

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27
Q

non-arteritic ischemic optic neuropathy associated with?

A
  • microvascular disease
  • post-surgical
  • small c/d ratio (segmental pallor)
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28
Q

papilledema sx ?

A

position dependent headaches, pulsatile tinnitus

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29
Q

papilledema findings?

A

bilateral disc elevation with blurred margins, discs not pallid

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30
Q

senile cataract presentation

A

painless, progressive vision loss, increasing difficulty with glare

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31
Q

senile cataract physical exam?

A

lens not clear; nucleus has hazy, yellow-brown appearance

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32
Q

senile cataract forms because…

A

degenerative clouding of the normally clear crystalline lens with age

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33
Q

senile cataract tx?

A

surgical extraction

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34
Q

primary open angle glaucoma presentation?

A

decreased visual fields, defects

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35
Q

primary open angle glaucoma findings?

A

high disc to cup ratio 0.8. normal vessels, increased IOP

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36
Q

what is the pathophys of glaucoma?

A

the high IOP (>21 mm Hg) leads to a thinned neuro-retinal rim and cup enlargement

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37
Q

Dry age related macular degeneration presentation

A

bilateral dimming of vision centrally. intact in extrinsic visual fields

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38
Q

Dry age related macular degeneration exam?

A

many yellow subretinal deposits called drusen which show atrophy in the central macula

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39
Q

Dry age related macular degeneration tx?

A

Risk factor management of smoking and vitamin supplementation. non-urgent next available appointment to optho

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40
Q

Wet age related macular degeneration presentation

A

sudden change and loss of central vision

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41
Q

Wet age related macular degeneration exam?

A

subretinal fluid and hemorrhages

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42
Q

Wet age related macular degeneration tx?

A

intraocular injections of anti-VEGF and other antibodies. 1 week to optho

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43
Q

AMD facts

A

most common cause of severe vision loss of people over 60. hard to read, drive, recognize faces

44
Q

orbital floor fracture presentation?

A

ecchymosis around eye, subconjunctival hemorrhage. affected eye appears lower than the normal one. pain

45
Q

orbital floor fracture exam?

A

orbital floor fracture with CT showing air fluid level in the maxillary sinus

46
Q

orbital floor fracture tx?

A

urgent optho exam and repari of facial fracture within 5 days

47
Q

sub-conjunctival hemorrhage spontaneous?

A

don’t worry about it. If pt is anticoagulated, consider checking INR’s

48
Q

hyphema presentation?

A

punch in eye and blood pooled in bottom of anterior chamber. Pain with eye, blurry vision

49
Q

hyphema exam?

A

layered blood in dependent portion of the anterior chamber. conjunctival injection

50
Q

hyphema tx?

A

EMERGENT referral to optho. Put shield over affected eye and monitor intra-ocular pressure. Opthalmologist will manage the possible spontaneous re-bleed which can happen days afterwards

51
Q

subconjunctival hemorrhage presentation

A

no trauma, pain or itching, but usually sponatenous

52
Q

subconjunctival hemorrhage exam?

A

extravasated blood beneath the conjunctiva without engorgement of conjunctival vessels.

53
Q

subconjunctival hemorrhage tx?

A

don’t worry. go home and it will resolve. use artifical tears if irritated

54
Q

follicular conjunctivitis (adeno) presentation

A

redness, eye grittiness and discharge. blurry vision. constitutional sx like sore throat and swollen glands

55
Q

follicular conjunctivitis (adeno) exam?

A

diffuse conjunctival injection involving bulbar and tarsal conjunctiva. muco-serous discharge. follicular pattern

56
Q

follicular conjunctivitis (adeno) tx?

A

self-limited process. use of anti-histamine drops

57
Q

bacterial conjunctivitis presentation

A

discharge from eye with tons of goop

58
Q

bacterial conjunctivitis exam?

A

moderate discharge from eye with bulbar and tarsal conjunctiva.

59
Q

bacterial conjunctivitis tx?

A

erythromycin ointment or 10% sulfacetaminde drops QID x 5 days. Response within 24-48 hours

60
Q

Chalazion presentation?

A

painless nodul on eyelid

61
Q

Chalazion exam?

A

firm, non-tender nodule on eyelid. no edema, erythema, ulceration

62
Q

Chalazion tx?

A

warm compresses at first, persistent, then go for I&D if causing vision change (astigmatism)

63
Q

Chalazion what is it?

A

focal area of inflammation of eyelid related to meibomian gland obstruction which makes goopy eye stuff

64
Q

Blepharitis presentation?

A

morning crusting of eyelids

65
Q

Blepharitis exam?

A

flaky crusting of lashes without discharge. some conjunctiva injection

66
Q

Blepharitis tx?

A

warm compresses + erythromycin ointment BID x 2weeks

67
Q

what does Blepharitis come from?

A

seborrhea, staph, rosacea

68
Q

Herpes simplex keratitis presentation?

A

photophobia, foreign body sensation, tearing of left eye. moderately swollen lid. no discharge. conjunctival injection with no tarsal involement

69
Q

Herpes simplex keratitis exam?

A

linear opacity with branching of terminal bulbs in cornea that is grayish white, turning yellow in fluorescein staining. DENDRITE

70
Q

Herpes simplex keratitis tx

A

referral to optho within 1-2 days for topical or systemic antiviral agent.

71
Q

Herpes simplex keratitis comes from?

A

expression of HSV latent in the trigeminal ganglion. It’s an eye cold sore. can cause keratitis scarring

72
Q

bacterial keratitis with hypopyon presentation?

A

contact lens wearer reports 3 days of irritation, increasing discharge and declining vision

73
Q

bacterial keratitis with hypopyon exam?

A

irregular white corneal opacity that stains with fluorescein. White cells layering anterior to the iris

74
Q

bacterial keratitis with hypopyon tx?

A

emergency referral to optho for empiric topical abx tx and/or cultures

75
Q

bacterial keratitis with hypopyon sequelae?

A

corneal ulceration with scarring, perforation, and loss of the eye.

76
Q

acute angle closure glaucoma presentation?

A

“worst headache of life” with a red eye. slightly decreased vision in involved eye.

77
Q

acute angle closure glaucoma exam?

A

hazy cornea with diffuse injection of the conjunctiva. High IOP

78
Q

acute angle closure glaucoma tx?

A

EMERGENCY optho consult with topical beta-blocker and alpha-agonist. Definite treatment is laser iridotomy with fellow eye treatment within several days

79
Q

infantile esotropia presentation?

A

baby with crossed eyes with normal development otherwise

80
Q

infantile esotropia exam?

A

deviation of eye inwards towards nose

81
Q

infantile esotropia tx?

A

optho within a few weeks. confirm ocular misalignment. patch the bad eye to avoid amblyopia in the left eye. strabismus surgery possible

82
Q

6th nerve palsy presentation

A

unable to abduct eye. anisocoria

83
Q

6th nerve palsy tx?

A

maybe due to microvascular stuff. rule out tumor or infiltrative process with imaging

84
Q

6th nerve palsy etiology?

A

elevated ICP, head trauma, meningeal inflammation

85
Q

3rd nerve palsy presentation

A

dipolopia with a blown pupil

86
Q

3rd nerve palsy etiology?

A

PCA aneurysm with compression if blown pupil. if ischemic, usually a pinpoint pupil

87
Q

horner syndrome presentation

A

pain in neck, drooping eyelid, unilateral headache

88
Q

horner syndrome exam?

A

one pupil smaller than the other and ptosis

89
Q

horner syndrome etiology?

A

traumatic carotid dissection

90
Q

retinoblastoma presentation

A

unusual white reflex in pupil (leukocoria)

91
Q

retinoblastoma exam?

A

leukocoria

92
Q

retinoblastoma tx?

A

urgent referral to opthalmologist for surgery, radiation or other destruction

93
Q

diabetic retinopathy presentation

A

diabetic person with worsening vision

94
Q

diabetic retinopathy exam?

A

cotton wool spots, exudates on retina and dot blot hemorrhages

95
Q

diabetic retinopathy tx?

A

non-urgent referral to optho to check for neovascularization. used to use laser to stop neovascularization. Also can use anti-vegf therapy

96
Q

Reiter’s syndrome (iritis) presentation?

A

red eye and light sensitivity. photophobia

97
Q

Reiter’s syndrome (iritis) findings?

A

injected eye with ciliary flush. focal opacities in the red reflex are keratic precipitates (cells) on inner surface of cornea (need slit lamp)

98
Q

Reiter’s syndrome (iritis) tx?

A

tons of steroids. also workup for other things like TB, sarcoid, syphilis, RA, etc.

99
Q

HSV opthalmicus presentation?

A

rash and burning and itching around eye

100
Q

HSV opthalmicus findings?

A

eye injection but no discharge

101
Q

HSV opthalmicus tx?

A

systemic antiviral therapy within 72 hours

102
Q

orbital cellulitis presentation?

A

inflamed, swollen eyelid

103
Q

orbital cellulitis findings?

A

post-septal orbital findings - proptosis, reduced vision, relative afferent pupillary defect,restricted EOM.

104
Q

orbital cellulitis tx?

A

urgent to hospital for tx with IV abx.

105
Q

Graves presentation?

A

bulging eyes, diplopia

106
Q

Graves findings?

A

prominent lid retraction with sclera visible above the superior limbus

107
Q

Graves tx?

A

thyroidectomy, methimazole

Opthalmology (1 decks)

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