OPTHO ALL UNDERLINED Flashcards
Preseptal cellulitis has NO PROPTOSIS
NO restricted ocular motility
NO PAIN with EOM
And NO Optic neuropathy
Compare this with Orbital cellulitis
As they both presents with a swollen eye/ eye lid 2/2 staph and strep
But cellulitis has Proptosis and Restricted EOM with Pain
What is the Treatmetn for orbital cellulitis
IV! ABX
( Vanc and ampicillin/ Sulbactam)
x72 hrs then Oral for 1 week
A child under 5 years old that presents with Leukocoria
Retinoblastoma
Can be unilateral, bilateral or multi focal
How do you do an eye exam for corneal abrasions
Slit lamp and evert the eye to look for foreign bodies
Know that alkali burns are worse than acidic burns
When should you start treatment for chemical injury to the eyes
BEFORE EVALUATON!
Copious irrigation for at least 30 minutes
Wait 5 – 10 minutes after irrigation stopped, then check pH in the fornices using litmus paper
Continue irrigation until neutral pH is achieved
Topical anesthetic (proparacaine)
Evert lids to flush out retained chemicals
IOP should be assessed
What must you do to look for foreign bodies of the cornea
EVERT the lids
CAPITILIZED IN THE SLIDES
If a pt has a high speed hx with foreign body of the corneal
What imaging should you order
CT scan !
A pt that presents with a detetacble penetration site of the eye with an irregular shaped pupil
With a trans illumination defect
(red reflex when there shouldn’t be)
Intraocular foreign body
(Pupil peaked to the point of injury)
UNDERLINED: CT SCAN!!
Who should lid lacerations be treated by
Refer to oPHthomology
If:
It involves canalicular system
Associated with ruptured globe/intraocular foreign body
Involves levator (ptosis present)
Visible orbital fat (indicates penetration of orbital septum)
Extensive tissue loss (more than 1/3 of lid)
A pt presents with an irregularly dilated pupil that reacts poorly to light
(Responds with SLOW accommodation)
Typically unilateral and mc in women who also have a loss of DTRs
Think
Adíes tonic pupil
2/2 Denervation of parasympathetic supply to the sphincter pupillae and the ciliary muscle
Confirming diagnosis
- Instill 0.125% pilocarpine in both eyes
- Adie’s pupils will constrict (hypersensitive)
- Normal pupils will not constrict
A pt presents with a small, slow reacting or not at all reacting to light pupil
However does respond to accommodation (light near dissociation)
Think
Argyle Robertson Pupil
Assoc with syphillis
Is papilledema bilateral or unilateral
Bilateral
Sign of underlying D/o with pressure in or on the nerves of the brain ( mass, or CSF flow)
What must the Nuero imaging be to do a LP
NORMAL!
A pt presents with a unilateral swollen disc with flame shaped hemmorages
What is the DDx
Thing Ischemic Optic Neuropathy
(AAION if over 60 -GIANT CELL Arteritis)
(NAION if under 60)
What is the ESR in giant cell arteritis
ESR is greater than 50 (in red on the slides)
An older pt presents with sudden painless vision loss
That often starts unilaterally then progresses to bilateral
Think
NAION or AION
Also look for Headache, Scalp tenderness, Jaw Claudication
R/o TIA
HTN, DM, and Anemia
A female pt presents w/ unilateral vision loss with orbital eye pain with EOM developing over Days
Frontal HA and globe tenderness
Think
Optic neuritis, may be 1st sign of MS
Should you start optic neuritis pts on oral steroids/>?
NO!!
Start on IV pulitile steroids
Oral can increase incidence rates
What is LR6SO4
Lateral Recutus CN6
Sup. Oblique CN4
All others are controlled by CN III
(SR, IR, IO, MR, Levator palpebrae, and pupillary sphincter)
A pt presents with an eye that is “down and out”
What CN palsy
III
A pt with a down and out and DILATED pupil =
BAD!!
MRI to R/o aneurysm
A pt has unilateral hypertrophic in primary and left gaze
And the inferior oblique overreacts w with up and left gaze
What palsy?
CN IV
A pt with a unilateral left gaze defect, in that one eye can look left but the other eye remains fixed
. what CN palsy
CN VI
A pt with a stroke and now CN VI palsy should get what surgery
Strabismus surgery for chronic stable deviation
What is the blood supply to the inner retina?
The outer retina?
Inner: Central retinal artery
Outer: The choroid
Supplies the phot receptors
What is the Tx for Giant Cell arteritis
High dose steroids
A pt that has Blood and thunder fundus
Think
Central Retinal Vein Occlusion
What are the differences of Ischemic vs non ischemic retinal vein occlusion
Can be DDx with APD reflex
Ischemic will have the defect
and non ischemic wont
When would you use Intravitreal anti VEGF injections or PRP
If Neovascularization or macular edema present with Retinal vein occlusion
IS retinopathy common in Type I dm ?
Rare, more common in type II
DM is the leading cause of blindness in the US ages 20-64
What is the 4-2-1 rule for Non proliferative DM retinopathy
Severe – 4-2-1 rule
Any of the following:
-4 quadrants of severe retinal hemorrhages
-2 or more quadrants of significant venous beading
-1 or more quadrants of moderate IRMA
A pt with DM retinopathy with neovascular changes should get what approach to tx
Referral to ophthalmology
Anti-VEGF injections
Pan Retinal Photocoagulation (PRP)
What is the common complaint of a pt with retinitis pigmentosa and what is the classic sign
Difficulty driving at night
And golden ring sign:
Yellowish-white halo surrounding optic disc
Eventually replaced with pigmentation
A pt that has flashes and floaters in a retinal detachment
Has what type of detachment
Rhegmatogenous
What is the hallmark of hypertensive retinopathy
Diffuse arteriolar narrowing
“Copper-wire vessel” – arteriolar narrowing
—Yellowing of the linear light reflex
“Silver wire” – sclerosis of the vessel
Can you use tamoxifen and chlorpoquine together
No
Can cause blindness
“Bulls eye maculopathy”
Think
Chloroquine toxicity
How will a nuclear congenital cataract present
opacity within the fetal nucleus of the eye
How will an anterior polar congenital cataract present in the eye
Often flat and visually insignificant
How ill a leticonus congenital cataract present
A protrusion in the lens capsule
Anterior or posterior
-May be opacified
What is the tx approach to congenital cataracts
This is an emergency
Referral to Peds and ortho stat!
What is the differnce 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
If we see quivering of the iris or lens think
Subluxation or dislocation
Vitreous opacities in the shape of a ring (Weiss rings )
Think
Vitreous detachment
Refer to optó/optho
Photocoagulation/cryotherapy may be necessary if retinal break/tear/detachment occurs
How can you r/o vitreous opacities and retinal tears
B scan ultrasound
May need to treat with vitrectomy
What is the prominent feature of Scleritis
Severe boring eye pain
That radiates to the jaw, forehead, or brow
Awaken from sleep
Blue appearing scleritis
Think
Necrotizing scleritis
Phenylephrine test for scleritis
Phenylephrine 2.5% topically
—After 15 min scleral vessels DO NOT blanch
What disorder is assoc with ant. Uveitis
HLA-b27 d/o
Most common cause of posterior uveitis
CMV
What is the most common severe infection affecting the eye
CMV in HIV pts
Most common finding are cotton wool spots
Treatment for CMV uveitis
Infx dz referral
HAART tx and oral valganciclovir
If a pt has necrotizing rheumatoid arthritis of the eye
What can you not give them
Topical steroids
Increases risk of perforation
Just give lubricants and nsaids
Should you give topical steroids in herpes simplex keratitis
No can lead to ocular perforation
What is one of the most common causes of bacterial keratitis
Contact lens wearer
A pt has outdoor eye truama involving vengativa matter
Think
Fungal keratitis
Will see a feathery white opacity
+/- hypopyon
DO NOT USE TOPICAL STEROIDS
What drugs cause corneal pigmentation
ICAP
Indocethacin
Chlorquinilone
Amioderone
Phenothiazines
Just Dc the drug
What is munsons sign
Pointed eyeball seen in keratoconus
What is arcus senilis
Gray, white or yellow deposits in the peripheral cornea
Age-related change
Abnormal hyperlipoproteinemia in younger patients
- Under 40?
- Check systemic lipids!
What is the physical exam finding for viral conjunctivitis
Preauricular lymphadenopathy (tender) -Differentiator of viral vs bact
What is the approach to chlamydia conjunctivitis
SEND to ophthalmology ASAP!
Corneal ulcer from gonococcal can perforate quickly!
If you see mucopurulent D/c
It’s
Bact conjunctivitis
A pt with conjunctivitis and intense itching
Think
Allergic conjunctivitis
Which invades the cornea
Pterygium or pinguecula ?
Pterygium
What is the Most common cause of bilateral and unilateral proptosis in adults
Thyroid eye D/z
Tx for thyroid eye dz
Mild
Artificial tears
Head elevation at night
Eyelid taping
Moderate to severe: Oral prednisolone Orbital decompression Repair of lid retraction Orbital radiation Strabismus surgery
What is the permanent tx for lagopthalmos
Temporary
-Suture lids together (tarsorrhaphy)
Permanent
-Gold weight surgically inserted into upper lid
3 types of eye deviations
Orthophoria
-No deviations
Heterophoria:
-Normal deviation
Not present on cover-uncover
Eso, Exo, Hyper, Hypo, Cyclo
Heterotropia:
-Deviated (intermittent or constant) when using both eyes
Picked up on cover-uncover test
Eso, Exo, Hyper, Hypo, Cyclo
