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NSR 251A: optho, pulm, renal, GU, heme/onc > Optho COPY > Flashcards

Optho COPY Flashcards

1
Q

Medial Wall Fracture of the orbit involves

A

ethmoid and sphenoid sinus

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2
Q

Inferior wall fracture of the orbit can involve

A

maxillary sinus and inferior rectus muscle entrapment

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3
Q

Expothalmos

A

bulging of the eyeball, anterior protrusion from orbit

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4
Q

Enopthalmos

A

Recession of the eyeball, posterior displacement within the orbit

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5
Q

CN III controls which muscles

A
  • Oculomotor nerve
  1. levator palpebrae superioris (lifts/elevates eyelid)
  2. superior rectus: elevates, adducts, medially rotates eye
  3. inferior rectus: depresses, aabducts laterally rotates tehe eye
  4. medial rectus: adducts the eye
  5. inferior oblique: pulls the back of the eye down (elevates, abducts, laterally rotates the eye)
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6
Q

CN IV controls which muscles

A
  • trochlear nerve
  1. superior oblique
    1. pulls the back of the eye up
    2. depresses, abducts and internally rotatest the eye
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7
Q

CN VI controls which muscles

A
  • abducens nerve
  1. lacteral rectus
    1. abducts the eye
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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)
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9
Q

Abducent Nerve Palsy

A

CN VI palsy

  • adducted eye (Medial Rectus is active)
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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
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11
Q

3 layers of the eye

A
  1. Fibrous
    1. ​outer, white portion (sclera) + cornea
  2. Choroid/Vascular Uvea
    1. middle, blood vessels and ciliary body related structures
  3. Neural layer:
    1. inner, contains the retina with the photo receptors
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12
Q

Lens flattening vs bulging

A
  • flattened lens for distance vision
  • bulged lens for near vision
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13
Q

Ciliary body

A

ring of smooth muscle attached to the lens

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14
Q
A
  1. macula lutea
  2. fovea centralis:
    1. highest concentration of cones for bright light and color vision
  3. blood vessels
  4. optic disc:
    1. area where blood vessels and optic nerve exits
      1. no photo receptors = “blind spot”
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15
Q

Define Fundus

A

it is the inner surface of the back of the eye, where the retina is located

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16
Q
A
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17
Q

Lacrimal Gland

A
  • produces watery lacrimal fluid (tears)
    • contains lysozyme to prevent bacterial growth
    • located above and slightly lateral to the eye
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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
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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
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20
Q

Glands of Zeis (sebaceous)

A
  • secretes oil onto the eyelashes
    • lubricates the eyelashes
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21
Q

ocular conjunctive vs palpebral conjunctiva

A
  • ocular conjunctiva: on the surface of the eye
  • palpebral conjunctiva: inside the eyelid
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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
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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)
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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
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25
Q

Pupillary light reflex

A
  • 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
      *
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26
Q

Anisocoria

A

asymmetric pupil

can be variant or pathological

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27
Q

Pineal gland and vision

A

sleep and wake cycle

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28
Q

hypothalamus and vision

A

sleep and wake cycle

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29
Q

superior colliculus and vision

A

visual reflexes

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30
Q

Left vs right Visual Field Processing

A
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31
Q

myopia

A

impaired distance vision

  • impaired distance vision
    • aka “nearsightedness”
    • when you have an elongated eyeball
      • treated with a concave lense
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32
Q

Hyperopia

A

impaired near vision

  • “farsightedness”
    • when you have a short eyeball
      • treated with a convex lense
33
Q

presbyopia

A
  • type of hyperopia (loss of near vision) due to aging
34
Q

emmetropic

A

normal vision

35
Q

congenital glaucoma

A
  • incorrect development of the eye’s drainage system before birth
  • sxs: enlarged eyes, cloudiness of the cornea, and photosensitvity

autosomal recessive inheritance

36
Q

Congenital Cataracts

A
  • clouding of the lens of the eye
  • part of many birth defects
  • Most important:
    • non-dysjunctions
      • Down syndrome (trisomy 21)
      • Trisomy 13
37
Q

inherited retinal degeneration

A

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
Q

Strabismus genetics

A
  • autosomal dominant and autosomal recessive inheritance
39
Q

Iritis

A

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
Q

Posterior Uveitis

A

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
Q

Episcleritis

A

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
Q

Scleritis

A

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
Q

Keratitis

A

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
Q

Endophthalmitis

A

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
Q

Astigmatism

A

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
Q

Myopia

A

“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
Q

Hyperopia

A

“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
Q

Strabismus

A

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
Q

acute narrow angle-closure glaucoma

A

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
Q

Chronic open angle glaucoma

A
  • 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
Q

Amblyopia

A

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
Q

Amaurosis Fugax

A

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
Q

Central Retinal Vein Occlusion

A
  • 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
Q

Central Retinal Artery Occlusion

A
  • 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
Q

Vitreous Detachment

A
  • 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
Q
A

Hyphema

blood in the anterior chamber of the eye

  • referral, eye shield
57
Q
A

Hypopyon

collection of neutrophils and fibrin in the anterior chamber of the eye

  • often associated with endophthalmitis
  • referall to surgery and intravitreal abx
58
Q

Globe Rupture

A

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
Q

Blowout Fracture

A

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
Q

Diabetic Retinopathy

A

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
Q

Hypertensive Retinopathy

A
  • 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
Q

Retinal Detachment

A

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
Q

Macular Degeration

A

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
Q

Orbital Cellulitis

A
  • 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
Q

Papilledema

A

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
Q

Optic Neuritis

A

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
Q

ptosis

A

drooping of eyelid

can be associated with CN III deficit or levator palpebrae muscle

referral to optho

68
Q

Proptosis

A
  • 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
Q

Hordeolum

A

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
Q
A

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
Q
A

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
Q

Chalazion

A

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
Q

Blepharitis

A

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
Q

Dacrocystitis

A

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
Q

Corneal Abrasion tx

A

abx ointment (aminoglycoside tobramycin, gentamicin), or erythromycin and pupillary dilation

plus the tetanus immunization!!!

76
Q

pterygium

A

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
Q

Ocular Herpes

A

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
Q

Cataract

A

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
Q

Subconjuctival Hemorrhage

A

usually result of minor local trauma, straining, sneezing, or coughing

  • diagnosis is clinical
  • tx: reassurance = should resolve within 2 weeks

NSR 251A: optho, pulm, renal, GU, heme/onc (9 decks)

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