Pestana Ophthalmology

Question 1

3 ophthalmologic conditions that affect children

Answer 1

strabismus
retinoblastoma
congenital cataract

Question 2

What is amblyopia and what is it usually caused by?

Answer 2

vision impairment that results from an inability of the brain to correctly process and merge visual input from both eyes during the first 6-7 yrs of life, commonly due to misalignment of the eyes (strabismus)
As a result, the brain suppresses vision input from the eye and, even if the eye is perfectly normal, resulting in permanent cortical blindness

Question 3

What is strabismus?

Sequelae if not surgically corrected?

Answer 3

misalignment of the two eyes (can be esotropia (eyes cross in) or exotropia (eyes turn out)

Can lead to amblyopia (lazy eye)

Question 4

How do you diagnose strabismus

Answer 4

flashlight - reflection of the light comes from different areas of the cornea in each eye

Question 5

What should a white pupil in a baby make you think of? 2

Answer 5

Retinoblastoma or congenital cataract

Question 6

∆ btwn cataracts and glaucoma

Answer 6

cataract - clouding of the normally clear lens

glaucoma - increased intraocular/fluid pressure

Question 7

5 ophthalmologic emergencies

Answer 7

chemical burns of the eye
acute angle glaucoma 
retinal detachment 
embolic occlusion of the retinal artery
orbital cellulitis

‘Orbital CARE”

Question 8

how does acute angle glaucoma present?

Answer 8

• very severe eye pain or frontal HA, typically begins in the evening when the pupils have been dilated for severeal hours (ex: post TV/movie marathon)
• pts report seeing halos around lights
• pupil is mid-dilated and non-reactive to light
• cornea is cloudy with greenish hue
• eye feels “hard as a rock”

Question 9

acute angle glaucoma treatment?

Answer 9

• laser beam (to drill hole in iris to provide drainage route for fluid in anterior chamber)

while awaiting for the ophthalmologist:

• Carbonic anhydrase inhibitor (Diamox)
• topical ß blockers
• a2 agonist
• mannitol
• pilocarpine

Question 10

How does orbital cellulitis present?

Answer 10

febrile
eyelids are hot, tender, red, swollen
pupil is dilated and fixed
eye has very limited ROM

Question 11

orbital cellulitis treatment?

Answer 11

emergency CT and drainage

Question 12

treatment of chemical burns of the eye

Answer 12

massive irrigation with plain water/NS ASAP

Question 13

symptoms of retinal detachment

Answer 13

pt reports

• seeing flashes of light
• having floaters in the eye (# of floaters give a rough idea of the magnitude of the problem)

Question 14

retinal detachment treatment

Answer 14

laser “spot welding” to protect the remaining retina

Question 15

symptoms of embolic occlusion of the retinal artery

Answer 15

sudden loss of vision in one eye

Question 16

management of an elderly person who suddenly develops vision loss in one eye

Answer 16

think embolic occlusion of the retinal artery!!

Tx: breathe into paper bag and repeatedly press hard+release pressure on the eye while en route to the ER (idea is to vasodilate and shake the clot into a more distal location so that the ischemic area is smaller)

Question 17

Patients diagnosed with Type I DM develop eye problems after how many years?

Answer 17

~20 years