Optho COPY Flashcards
1
Q
Medial Wall Fracture of the orbit involves
A
ethmoid and sphenoid sinus
2
Q
Inferior wall fracture of the orbit can involve
A
maxillary sinus and inferior rectus muscle entrapment
3
Q
Expothalmos
A
bulging of the eyeball, anterior protrusion from orbit
4
Q
Enopthalmos
A
Recession of the eyeball, posterior displacement within the orbit
5
Q
CN III controls which muscles
A
- Oculomotor nerve
- levator palpebrae superioris (lifts/elevates eyelid)
- superior rectus: elevates, adducts, medially rotates eye
- inferior rectus: depresses, aabducts laterally rotates tehe eye
- medial rectus: adducts the eye
- inferior oblique: pulls the back of the eye down (elevates, abducts, laterally rotates the eye)
6
Q
CN IV controls which muscles
A
- trochlear nerve
- superior oblique
- pulls the back of the eye up
- depresses, abducts and internally rotatest the eye
7
Q
CN VI controls which muscles
A
- abducens nerve
-
lacteral rectus
- abducts the eye
8
Q
Oculomotor Nerve Palsy
A
CNIII palsy
- ptosis (eyelid droop)
- dilated pupil (dilator pupillae active)
- eye abducted (LR is active)
- eye depressed (SO active)
9
Q
Abducent Nerve Palsy
A
CN VI palsy
- adducted eye (Medial Rectus is active)
10
Q
Where does aqueous humor drain out of the eye
A
- through the trabecular network and the Canal of Schlemm
- regulates the intra-ocular pressure
11
Q
3 layers of the eye
A
-
Fibrous
- outer, white portion (sclera) + cornea
-
Choroid/Vascular Uvea
- middle, blood vessels and ciliary body related structures
-
Neural layer:
- inner, contains the retina with the photo receptors
12
Q
Lens flattening vs bulging
A
- flattened lens for distance vision
- bulged lens for near vision
13
Q
Ciliary body
A
ring of smooth muscle attached to the lens
14
Q
A
- macula lutea
-
fovea centralis:
- highest concentration of cones for bright light and color vision
- blood vessels
-
optic disc:
- area where blood vessels and optic nerve exits
- no photo receptors = “blind spot”
- area where blood vessels and optic nerve exits
15
Q
Define Fundus
A
it is the inner surface of the back of the eye, where the retina is located
16
Q
A
17
Q
Lacrimal Gland
A
- produces watery lacrimal fluid (tears)
- contains lysozyme to prevent bacterial growth
- located above and slightly lateral to the eye
18
Q
meibomian (tarsal) glands
A
- produces a thin oil which it release through multiple ducts inside the eyelid
- maintains a protective layer over the eye that keeps the eyelids from sticking together
19
Q
Moll’s (ciliary) glands
A
- create eye boogers
- produce a gritty lipid on the margin of the eyelid
- extra active at night
- prevent bacterial growth and pathogen entry
20
Q
Glands of Zeis (sebaceous)
A
- secretes oil onto the eyelashes
- lubricates the eyelashes
21
Q
ocular conjunctive vs palpebral conjunctiva
A
- ocular conjunctiva: on the surface of the eye
- palpebral conjunctiva: inside the eyelid
22
Q
What is contained within and the function of the lacrimal apparatus?
A
- produces and collects tears
- includes:
- lacrimal gland: produces tears
- the tears then collect in the lacrimal sac as they drain out of the eye
- then they drain down into the nasolacrimal duct to the nasal cavity
23
Q
Miosis
A
constricted pupil
- when the sphincter pupillae contracts via parasympathetic innvervation
mydriasis = dilated pupil
- bright light
- parasympathetic innervation (Ach)
- CN III
- opioids (morphine, heroine)
24
Q
mydriasis
A
- pupil dilates
- when the dilator pupillae contracts via sympathetic innveration
miosis = constricted pupil
- CN V stimulation
- anti-cholinergics
- serotonin, SSRIs
- NE
- stimulant drugs
- opioid withdrawal
25
Pupillary light reflex
* constriction of both pupils in reponse to light
* CONSTRICTION (miosis)
* sensory portion: _CN II_, retina, optic nerve, optic chiasm, optic tract to midbrain
* Motor portion: _parasympathetic innervation_ via both oculomotor nerves **CNIII** to both sides of iris
* DILATION (mydriasis)
* motor: _sympathetic innervation_ via **CN V**
*
26
Anisocoria
asymmetric pupil
can be variant or pathological
27
Pineal gland and vision
sleep and wake cycle
28
hypothalamus and vision
sleep and wake cycle
29
superior colliculus and vision
visual reflexes
30
Left vs right Visual Field Processing
31
myopia
**impaired distance vision**
* impaired distance vision
* aka "nearsightedness"
* when you have an _elongated eyeball_
* treated with a **concave lense**
32
Hyperopia
**impaired near vision**
* "farsightedness"
* when you have a _short eyeball_
* treated with a **convex** lense
33
presbyopia
* type of **hyperopia** (loss of near vision) due to aging
34
emmetropic
normal vision
35
congenital glaucoma
* incorrect development of the eye's drainage system before birth
* sxs: enlarged eyes, cloudiness of the cornea, and photosensitvity
**autosomal recessive inheritance**
36
Congenital Cataracts
* clouding of the lens of the eye
* part of many birth defects
* Most important:
* non-dysjunctions
* Down syndrome (trisomy 21)
* Trisomy 13
37
inherited retinal degeneration
a group of progressive, visually debilitating diseases
* lead to blindness caused by mutations in genes that cause photoreceptor cell death and associated vision loss
* include: **retinitis pigmentosa**
* inherited 3 ways: autosomal dominant, autosomal recessive and X-linked recessive
38
Strabismus genetics
* autosomal dominant and autosomal recessive inheritance
39
Iritis
most common form of uveitis
* inflammation of the iris
* s/sxs: **ciliary flush, miosis,** photophobia, and severe throbbing pain
* unilateral, blurred or decreased vision
* tx: topical steroid drops
40
Posterior Uveitis
uvea = choroid, ciliary body + iris
* s/sxs: **blurred** or **decreased vision** due to _problems with blood flow_ (in the choroid), unilateral
* tx: **systemic glucocorticoids**
41
Episcleritis
inflammation of the episclera
* s/sxs: distinguished from scleritis by **lack of severe pain & lack of photophobia**
* mild irritation of the palpebral conjuctiva
* diagnosis: slit lamp exam, blanching with phenylephrine
* tx: supportive care
* **systemic NSAIDs**
42
Scleritis
inflammation that involves the sclera and deep episclera
* women age 30-50 with *connective tissue disease*
* _s/sxs:_**deep, boring ache**, photophobia, unilateral, focal or diffuse eye redness
* can have **nodular** or **necrotizing**
* _diagnosis:_ clinical with slit lamp
* _tx:_ systemic corticosteroids and/or systemic immunosuppresive therapy (consult rheum AND ophtho)
43
Keratitis
inflammation of the cornea
* if bacterial:
* **staph, pseudomonas**
* _risk factors_: Bells palsy (dry eye surfaces) and improper contact lens use
* _s/sxs_: **sudden pain in the eye**, redness, reduced vision, photophobia, **ciliary injection, hazy cornea**, conjunctival erythema
* _diagnosis_:
* clinical, slit lamp, fluorescein
* _tx:_ topical **fluoroquinolones** (moxifloxacin)
* DO NOT PATCH
44
Endophthalmitis
infection/inflammation of the inner eye
* usually caused by *staph epidermidis* or *staph aureus*
* usually after surgery or penetrating ocular trauma
* s/sxs: **intense conjunctival hyperemia**, loss of red light reflex, eyelid edema, **hypopyon, ocular pain, vision loss**
* tx:
* intravitreal abx, maybe add IV abx
45
Astigmatism
variable curvature of the cornea or lense → difficult to focus light
* s/sxs: headache, eyestrain, distorted or blurred vision at any distance
* tx: **cylindrical lense** to correct shape
46
Myopia
"nearsightedness"
* point of focus is in front of retina b/c eye is too long or lense is too curved
* can see near objects but not far objects
* _dx_: visual acuity testing
* _tx:_ **concave lense**
47
Hyperopia
"farsightedness"
* point of focus is behind the retina b/c the eyeball is too short or the lense is too flat
* can see distant objects but not near ones
* _dx_: visual acuity testing
* _tx:_ convex lens
48
Strabismus
misalignment of one or both eyes
* stable ocular alignment not usually reached until ag 2-3mo, still persisting at 4-6 months? refer
* types: hypertropia (upward), hypotropia (downward), esotropia (inward), exotropia (outward)
* _dx_: cover-uncover test
* _tx:_ **patch the normal eye**, eyeglasses, corrective surgery if severe
49
acute narrow angle-closure glaucoma
increase IOP leading to damage of the optic nerve (**emergency**)
* _risk factors_: hyperopia, \>60yo, asian, hyperopia, females, narrow angle or large lens
* _s/sxs_: **sudden** onset of **severe ocular pain**, **unilateral**, halos around lights and tunnel vision (**loss of peripheral vision**)
* N/V, HA
* _dx_: tonometry (IOP\>21mmHg), optic disc blurring
* _tx:_ combination of topical agents (**timolol, apraclonidine, pilocarpine**) + systemic agents (**PO/IV acetazolamide** or IV mannitol)
* topical beta blockers
* alpha 2 agonists (*aproacloonidine, brimonidine*)
* miotics/cholinergics (*pilocarpine, carbachol*)
* prostaglandins (*latanoprost*)
* _definitive tx_: **iridotomy**
50
Chronic open angle glaucoma
* **slow, progressive _painless, bilateral_ peripheral vision loss**
* _risk factors_: AFrican American, \>40yo, family history, DM
* s/sxs: usually **asymptomatic** until late into onset
* **tunnel vision** progressing to central vision loss
* _physical exam_: **cupping of optic disc** (increased cup to disc ratio) [larger cup inside the disc]
* tx: **prostaglandin analogs** (1st line) **latanoprost**,
* beta blockers (timolol)
* alpha 2 agonists (brimonidine, apraclonidine)
* carbonic anhydrase inhibitor (acetazolamide)
* laser therapy
* surgery = last line
51
Amblyopia
decreased visual acuity of one eye due to disuse during visual development
* \*\*needs to be **treated before age 8** if you want to avoid SEVERE vision loss\*\*
* _risk factors_: strabismus, refractive errors (astigmatism, myopia, hyperopia), congenital cataract
* _s/sxs_: decreased visual acuity
* _diagnosis_: early screening
* _tx_: eyeglasses, patch the normal eye, cataract removal, tx of strabismus, atropine drops
52
Amaurosis Fugax
transient monocular vision loss that lasts minutes and spontaneously recovers
* usually a retinal ischemia or emboli, TIAs, giant cell arteritis, migraine, lupus
* _risk factors_: DM, heart disease, smoking, HTN, hyperlipidemia, age, cocain use
* _s/sxs_: vision loss that descends over the visual field (often described as a **curtain or shade**) that usually resolves **within the hour**
* _dx:_ clinical diagnosis
* _tx_: tx the underlying vascular issue
53
Central Retinal Vein Occlusion
* _risk factors_: associated with Afib and carotid disease
* HTN, advancing age, glaucoma, DM
* _s/sxs_: **sudden onset, severe, painless _unilateral_ vision loss**
* blood and thunder of the retina
* _dx_: fundoscopy
* _tx:_ globe massagem, refer to optho/ED
* decrease IOP
* tx HTN!
54
Central Retinal Artery Occlusion
* _risk factors_: associated with Afib and carotid disease
* HTN, advancing age, glaucoma, DM
* _s/sxs_: **sudden onset, severe, painless _unilateral_ vision loss**
* **cherry red spot on pale macula**
* _dx:_ fundoscopy
* _tx:_ globe massagem, refer to optho/ED
* decrease IOP
* tx HTN!
55
Vitreous Detachment
* can be associated with trauma
* hemorrhage in pts with DM
* _s/sxs_: complaints of mild vision loss, floaters, cobwebs or flashes of light
* refer to optho
56
Hyphema
blood in the anterior chamber of the eye
* referral, eye shield
57
Hypopyon
collection of neutrophils and fibrin in the anterior chamber of the eye
* often associated with **endophthalmitis**
* referall to surgery and intravitreal abx
58
Globe Rupture
**ophthalmologic emergency**
* significant visual acuity impairment, diplopia
* _dx_: r/o intraocular foreign body, check visual acuity
* DO NOT TOUCH EYE
* _tx_: ABCs, and stabilization
* apply rigid shield cup, keep head elevated at 30-40 degrees (do NOT want to increase IOP)
* **CT orbits if stable**
* **immediate surgical referral**
59
Blowout Fracture
fracture of the inferior floor of the orbit
* "trap door" or "white-eye fracture" in children = elastic bones can snap shut on muscle or other tissue
* _s/sxs_: decreased visual acuity, diplopia, eyelid edema
* _dx_: CT scan = **teardrop sign** (herniation of the orbital fat inferiorly
* _tx:_ nasal decongestant, avoid blowing nose or sneezing, corticosteroids
* abx: **ampicillin-sulbactam**, or **clindamycin**
* surgery if severe
60
Diabetic Retinopathy
gradual, bilateral, painless vision loss
* most common cause of new, permanent vision loss in 20-74yos
can have _non-proliferative_: microaneurysms, cotton wool spots, hard exudates, blot and dot hemorrhages
or
_proliferative retinopathy_: neovascularization, and maculoedema
* _dx_: fundoscopy, vital signs
* _tx_: non-proliferative = glucose control, laser treatment
* proliferative = **VEGF inhibitors** (bevacizumab), laser photocoagulation, treatment, glucose control
61
Hypertensive Retinopathy
* associated with malignant HTN (uncontrolled high blood pressure)
* can be associated with _non-proliferative retinopathy_: microaneurisms, cotton wool spots, hard exudates, drussen bodies, **flame hemorrhages**
* or _proliferative retinopathy_: neovascularization + maculoedema
* _dx_: fundoscopy + vital signs
* _tx_: tx the HTN!!
* non-proliferative: laser treatment
* proliferative: **VEGF inhibitors** (bevacizumab), laser photocoagulation
62
Retinal Detachment
When retina separates from the choroid
* _risks_: myopia, previous cataract surgery, advancing age, trauma
* _s/sxs_: **sudden onset**, unilateral,, \*\*flashes of light\*\*, floaters, **spreading cutrain of darkness**
* _dx_: fundoscopy or ocular u/s
* _tx_: keep pt **supine** with head turned toward side of detachment
* emergent referal to retinal specialist to seal the defect
*
63
Macular Degeration
most common cause of permanent legal blindness in adults \>75yo
* **dry (atrophic)**: most common type and progressive (spanning over decades)
* **wet (neovascular or exudative**): occurs more rapidly and is more severe
* _s/sxs:_ **bilateral** progressive **central vision loss,**
* ****_central scotoma_, **metamorphopsia** (straight line appears bent)
* _dx_: dry = _drusen bodies_
* wet = _new, abnormal vessels_ that can cause hemorrhaging and scarring
* fundoscopy, **AMSLER GRID**
* ****_management of dry_: zinc and vitamins C&E can slow progression
* **_tx of wet_**: **intravitreal VEGF inhibitors** (bevacuzimab, ranicuzimab) = decrease new and abnormal vessel growth
* laser photocoagulation
64
Orbital Cellulitis
* _preseptal orbital cellulitis_ = outside of the orbit
* _postseptal orbital cellulitis_ = inside the orbit (especially from sinus infection from the **ethmoid sinus**
* _s/sxs_:
* preseptal and postseptal = tenderness, edema, erythema, discoloration of eyelid and fever
* postseptal = **decreased ocular mobility**, pain with eye movement, **proptosis**, and decreased visual acuity
* _dx_: clinical, **high resolution CT scan**
* _tx_: admission + IV abx
* **vancomycin + ceftriaxone** or **cefotaxime** (3rd gen)
* preseptal = outpatient if older than **_1 year_** oral **clindamycin** (to cover MRSA)
65
Papilledema
optic disc swelling associated with increased intracranial pressure
* pressure of brain on optic nerve = swelling of optic disc
* _s/sxs_: headache, nausea, **bilateral blind spots**, vision can be preserved
* swollen optic disc with blurred margin
* _dx_: fundoscopy, MRI or CT scan to r/o mass effect, lumbar puncture to test pressure of CSF
* _tx_: **acetazolamide** (decreases production of aqueous humor and CSF production) [carbonic anhydrase inhibitor and diuretic]
* tx the underlying cause
66
Optic Neuritis
inflammation of the optic nerve often due to acute inflammatory **demyelination** of the optic nerve
* associated with women 20-40yo, **multiple sclerosis**, and **ethambutol**
* _s/sxs_: **unilateral, painful vision loss**
* decrease in color vision, **central scotoma** over hours to a few days, ocular pain **worse with movement**
* 1/3 of pts have papillitis ( optic disc swelling)
* _dx_: clinical, MRI orbit, brain and spinal cord
* **swinging flashlight test**
* _tx_: IV corticosteroids (**methylprednisone**) followed by PO corticosteroids
* neuro and optho referral
67
ptosis
drooping of eyelid
can be associated with CN III deficit or levator palpebrae muscle
referral to optho
68
Proptosis
* aka exopthosis, protrusion of the eyeball
* \*\*most common in adults with **Graves Disease** (hyperthyroid)
* \*\*most common in children with **orbital cellulitis**\*\*
* _s/sxs_: red flags = eyepain/redness, HA, loss of vision, diplopia, fever, pulsating or neonatal
* _dx_:
* acute unilateral = **infection** or **vascular disorder**
* chronic unilateral = **tumor**
* **CT, MRI**
* order thyroid function testing
* _tx_: lubricate the cornea, systemic corticosteroid to reduce edema
* may need surgery
69
Hordeolum
aka stye = abscess of the meibomian gland, gland of Moll, or Gland of Zeiss)
* *staph aureus*
* _s/sxs_: pain, warm, erythematous, nodule or pustule on eyelid
* _diagnosis_: clinical
* _tx:_ warm compresses, can use oral abx if accompanied by preseptal orbital cellulitis (**dicloxacillin** or **erythromycin**)
* can add topical abx if actively draining (**erythromycin or bacitracin**)
70
**Entropion**
inversion of the eyelid
* usually associated with advancing age, but can also be postinfection, trauma, or blepharospasm
* _s/sxs_: foreign body sensation, tearing, red eye
* diagnosis is clinical
* _tx:_ surgery = refer to optho
71
**Ectropion**
* eversion of the lower eyelid
* caused by advancing age, relaxation of tissue, cranial nerve VII palsy, and post-traumatic/surgical changes
* _s/sxs_: tearing (because puncta are no longer in contact with the eye) dry eye
* diagnosis is clinical
* _tx_: lubrication eye drops at night
* tear supplements
* definitive tx = surgery, refer to optho
72
Chalazion
non-infectious blockage of internal Meibomian sebaceous gland, or zeiss gland
* often associated with acne rosacea
* _s/sxs_: **non-tender localized eyelid swelling** on the conjunctival surface of the eyelid
* often larger, firmer, slower growing, and less painful than hordeolum
* diagnosis is clinical
* _tx:_ warm compresses, abx eye drops
* referral to optho for injection of glucocorticoid or incision + curettage if does not resolve
73
Blepharitis
infection of the eyelids
* _acute ulcerative_: *staph or HSV*
* _acute non-ulcerative_: allergic
* _chronic_: meibomian gland dysfunction or seborrheic dermatitis
* _s/sxs_: **pruritus or burning of eyelid margin**, conjunctival irritation and tearing, photosensitivity, sensation of foreign body
* _dx_: slit lamp
* _tx:_ supportive
* warm compresses, cleansing of eyelid, keratoconjuctivitis sicca tx PRN
* can use abx for acute ulcerative and chronic or topical corticostosteroid of nonulcerative
74
Dacrocystitis
infection of the lacrimal sac
* often caused by *staph aureus and strep*
* _s/sxs_: pain, erythema, edema around lacrimal sac
* pressure on lacrimal sac may **exude mucoid or purulent material through the puncta**
* diagnosis is clinical
* _tx_: mild = warm compresses and **1st gen ceph,** or **penicillinase-resistant penicillin** (PO)
* IV abx
* not responding to tx? consider MRSA
75
Corneal Abrasion tx
abx ointment (**aminoglycoside** tobramycin, gentamicin), or **erythromycin** and pupillary dilation
plus the **tetanus immunization**!!!
76
pterygium
benign growth of the conjunctiva that results from chronic actinic irritation
* more common in sunny, dry, hot climates
* _s/sxs_: **fleshy, trianngular growth** of the _bulbar conjunctiva_ that can spread across the cornea and induce astigmatism/affect vision
* **pinguecula** doe NOT affect the cornea
* diagnosis is clinical
* _tx:_ arifical tears or short course of topical corticosteroids, reassurance
* referral if starting to affect vision for surgery
77
Ocular Herpes
corneal infection with HSV
* _s/sxs_: ocular pain, foreign body sensation, photophobia, blurred vision, watery discharge
* **dendritic lesions** with fluorescein stain
* _dx_: dendritic ulcer or **viral cx**
* _tx_: topical **ganciclovir** or **trifluride** OR PO acyclovir or valacyclovir
78
Cataract
thickened lens associated with aging, smoking, DM, long-term steroid use, trauma, congenital, and children exposed to too much O2
\*\*leading cause of reversible blindness\*\*
* _s/sxs_: cloudy/blurry vision, glare in vision (especially at night), halos, perception of faded color, yellowing/browning of vision
* NOT PAINFUL
* absent red light reflex, opaque lens
* cortical spokes, or posterior subcapsular
* _dx_: slit lamp exam
* _tx_: surgery
79
Subconjuctival Hemorrhage
usually result of minor local trauma, straining, sneezing, or coughing
* diagnosis is clinical
* tx: reassurance = should resolve within 2 weeks
