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Senoir 21-2 > OPTHO ALL UNDERLINED > Flashcards

OPTHO ALL UNDERLINED Flashcards

1
Q

Preseptal cellulitis has NO PROPTOSIS

NO restricted ocular motility
NO PAIN with EOM
And NO Optic neuropathy

A

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

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2
Q

What is the Treatmetn for orbital cellulitis

A

IV! ABX
( Vanc and ampicillin/ Sulbactam)
x72 hrs then Oral for 1 week

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3
Q

A child under 5 years old that presents with Leukocoria

A

Retinoblastoma

Can be unilateral, bilateral or multi focal

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4
Q

How do you do an eye exam for corneal abrasions

A

Slit lamp and evert the eye to look for foreign bodies

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5
Q

Know that alkali burns are worse than acidic burns

A
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6
Q

When should you start treatment for chemical injury to the eyes

A

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

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7
Q

What must you do to look for foreign bodies of the cornea

A

EVERT the lids

CAPITILIZED IN THE SLIDES

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8
Q

If a pt has a high speed hx with foreign body of the corneal

What imaging should you order

A

CT scan !

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9
Q

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)

A

Intraocular foreign body

(Pupil peaked to the point of injury)

UNDERLINED: CT SCAN!!

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10
Q

Who should lid lacerations be treated by

A

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)

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11
Q

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

A

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
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12
Q

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

A

Argyle Robertson Pupil

Assoc with syphillis

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13
Q

Is papilledema bilateral or unilateral

A

Bilateral

Sign of underlying D/o with pressure in or on the nerves of the brain ( mass, or CSF flow)

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14
Q

What must the Nuero imaging be to do a LP

A

NORMAL!

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15
Q

A pt presents with a unilateral swollen disc with flame shaped hemmorages

What is the DDx

A

Thing Ischemic Optic Neuropathy
(AAION if over 60 -GIANT CELL Arteritis)
(NAION if under 60)

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16
Q

What is the ESR in giant cell arteritis

A

ESR is greater than 50 (in red on the slides)

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17
Q

An older pt presents with sudden painless vision loss
That often starts unilaterally then progresses to bilateral

Think

A

NAION or AION

Also look for Headache, Scalp tenderness, Jaw Claudication

R/o TIA
HTN, DM, and Anemia

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18
Q

A female pt presents w/ unilateral vision loss with orbital eye pain with EOM developing over Days
Frontal HA and globe tenderness

Think

A

Optic neuritis, may be 1st sign of MS

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19
Q

Should you start optic neuritis pts on oral steroids/>?

A

NO!!
Start on IV pulitile steroids
Oral can increase incidence rates

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20
Q

What is LR6SO4

A

Lateral Recutus CN6

Sup. Oblique CN4

All others are controlled by CN III
(SR, IR, IO, MR, Levator palpebrae, and pupillary sphincter)

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21
Q

A pt presents with an eye that is “down and out”

What CN palsy

A

III

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22
Q

A pt with a down and out and DILATED pupil =

A

BAD!!

MRI to R/o aneurysm

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23
Q

A pt has unilateral hypertrophic in primary and left gaze

And the inferior oblique overreacts w with up and left gaze

What palsy?

A

CN IV

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24
Q

A pt with a unilateral left gaze defect, in that one eye can look left but the other eye remains fixed

. what CN palsy

A

CN VI

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25
Q

A pt with a stroke and now CN VI palsy should get what surgery

A

Strabismus surgery for chronic stable deviation

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26
Q

What is the blood supply to the inner retina?

The outer retina?

A

Inner: Central retinal artery

Outer: The choroid
Supplies the phot receptors

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27
Q

What is the Tx for Giant Cell arteritis

A

High dose steroids

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28
Q

A pt that has Blood and thunder fundus

Think

A

Central Retinal Vein Occlusion

29
Q

What are the differences of Ischemic vs non ischemic retinal vein occlusion

A

Can be DDx with APD reflex

Ischemic will have the defect

and non ischemic wont

30
Q

When would you use Intravitreal anti VEGF injections or PRP

A

If Neovascularization or macular edema present with Retinal vein occlusion

31
Q

IS retinopathy common in Type I dm ?

A

Rare, more common in type II

DM is the leading cause of blindness in the US ages 20-64

32
Q

What is the 4-2-1 rule for Non proliferative DM retinopathy

A

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

33
Q

A pt with DM retinopathy with neovascular changes should get what approach to tx

A

Referral to ophthalmology

Anti-VEGF injections

Pan Retinal Photocoagulation (PRP)

34
Q

What is the common complaint of a pt with retinitis pigmentosa and what is the classic sign

A

Difficulty driving at night

And golden ring sign:
Yellowish-white halo surrounding optic disc
Eventually replaced with pigmentation

35
Q

A pt that has flashes and floaters in a retinal detachment

Has what type of detachment

A

Rhegmatogenous

36
Q

What is the hallmark of hypertensive retinopathy

A

Diffuse arteriolar narrowing

“Copper-wire vessel” – arteriolar narrowing
—Yellowing of the linear light reflex

“Silver wire” – sclerosis of the vessel

37
Q

Can you use tamoxifen and chlorpoquine together

A

No

Can cause blindness

38
Q

“Bulls eye maculopathy”

Think

A

Chloroquine toxicity

39
Q

How will a nuclear congenital cataract present

A

opacity within the fetal nucleus of the eye

40
Q

How will an anterior polar congenital cataract present in the eye

A

Often flat and visually insignificant

41
Q

How ill a leticonus congenital cataract present

A

A protrusion in the lens capsule
Anterior or posterior
-May be opacified

42
Q

What is the tx approach to congenital cataracts

A

This is an emergency

Referral to Peds and ortho stat!

43
Q

What is the differnce between subluxation and dislocation of the lens

A

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
44
Q

If we see quivering of the iris or lens think

A

Subluxation or dislocation

45
Q

Vitreous opacities in the shape of a ring (Weiss rings )

Think

A

Vitreous detachment

Refer to optó/optho

Photocoagulation/cryotherapy may be necessary if retinal break/tear/detachment occurs

46
Q

How can you r/o vitreous opacities and retinal tears

A

B scan ultrasound

May need to treat with vitrectomy

47
Q

What is the prominent feature of Scleritis

A

Severe boring eye pain

That radiates to the jaw, forehead, or brow

Awaken from sleep

48
Q

Blue appearing scleritis

Think

A

Necrotizing scleritis

49
Q

Phenylephrine test for scleritis

A

Phenylephrine 2.5% topically

—After 15 min scleral vessels DO NOT blanch

50
Q

What disorder is assoc with ant. Uveitis

A

HLA-b27 d/o

51
Q

Most common cause of posterior uveitis

A

CMV

52
Q

What is the most common severe infection affecting the eye

A

CMV in HIV pts

Most common finding are cotton wool spots

53
Q

Treatment for CMV uveitis

A

Infx dz referral

HAART tx and oral valganciclovir

54
Q

If a pt has necrotizing rheumatoid arthritis of the eye

What can you not give them

A

Topical steroids

Increases risk of perforation

Just give lubricants and nsaids

55
Q

Should you give topical steroids in herpes simplex keratitis

A

No can lead to ocular perforation

56
Q

What is one of the most common causes of bacterial keratitis

A

Contact lens wearer

57
Q

A pt has outdoor eye truama involving vengativa matter

Think

A

Fungal keratitis

Will see a feathery white opacity
+/- hypopyon

DO NOT USE TOPICAL STEROIDS

58
Q

What drugs cause corneal pigmentation

ICAP

A

Indocethacin
Chlorquinilone
Amioderone
Phenothiazines

Just Dc the drug

59
Q

What is munsons sign

A

Pointed eyeball seen in keratoconus

60
Q

What is arcus senilis

A

Gray, white or yellow deposits in the peripheral cornea

Age-related change

Abnormal hyperlipoproteinemia in younger patients

  • Under 40?
  • Check systemic lipids!
61
Q

What is the physical exam finding for viral conjunctivitis

A 
Preauricular lymphadenopathy (tender)
-Differentiator of viral vs bact
62
Q

What is the approach to chlamydia conjunctivitis

A

SEND to ophthalmology ASAP!

Corneal ulcer from gonococcal can perforate quickly!

63
Q

If you see mucopurulent D/c

It’s

A

Bact conjunctivitis

64
Q

A pt with conjunctivitis and intense itching

Think

A

Allergic conjunctivitis

65
Q

Which invades the cornea

Pterygium or pinguecula ?

A

Pterygium

66
Q

What is the Most common cause of bilateral and unilateral proptosis in adults

A

Thyroid eye D/z

67
Q

Tx for thyroid eye dz

A

Mild
Artificial tears
Head elevation at night
Eyelid taping

Moderate to severe:
Oral prednisolone
Orbital decompression
Repair of lid retraction
Orbital radiation
Strabismus surgery
68
Q

What is the permanent tx for lagopthalmos

A

Temporary
-Suture lids together (tarsorrhaphy)

Permanent
-Gold weight surgically inserted into upper lid

69
Q

3 types of eye deviations

A

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

Senoir 21-2 (77 decks)

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