Review Deck 0-97 Flashcards
1
Q
If you wanna review anatomy:
A
First five slides of the review
2
Q
Orbicularis oculi - movement and innervation?
A
Closes the eyelids
CN VII (Facial)
3
Q
Levator palpebrae superioris - movement and innervation?
A
Opens the upper eyelid
CN III (Oculomotor)
4
Q
Mueller’s muscle - movement and innervation?
A
Assists in opening the eyelids
Sympathetic NS (running from a tiger - think Muller so you don’t get Mauled by a tiger)
5
Q
Medial rectus - movement and innervation?
A
Medial (adduction)
CN III
6
Q
Lateral rectus - movement and innervation?
A
Lateral (Abduction)
CN VI
7
Q
Superior rectus - movement and innervation?
A
Upward
CN III
8
Q
Inferior rectus - movement and innervation?
A
Downward movement
CN III
9
Q
Superior oblique - movement and innervation?
A
Intorsion/downward
CN IV
10
Q
Inferior oblique - movement and innervation?
A
Extorsion/upward
CN III
11
Q
Visual EOM chart:
A
Slide 8
12
Q
Helpful tip for EOM’s
A
Remember “opposite - oblique”
For example, if the patient is looking up and to the LEFT, the oblique is engaged for the RIGHT eye
13
Q
What is emmetropia?
A
Normal state; eyes see objects at infinity clearly while relaxed
14
Q
What is myopia?
A
Nearsighted
Eye is too long
15
Q
What is hyperopia?
A
Farsighted
Eye is too short
16
Q
What is astigmatism?
A
Corneal curvature is not equal
Football-shaped
17
Q
What is accommodation?
A
Ability of the eye to change the shape of the lens to read up close
18
Q
What is presbyopia?
A
The inability of the eye to change the shape of the lens to focus at near (old eyes)
19
Q
What to examine at MINIMUM during eye exam:
A
Visual acuity
Pupillary reaction
Extraocular movements
Direct ophthalmoscopy
20
Q
When would you NOT want to dilate somebody’s pupil?
A
If they have a shallow anterior chamber (you’ll cause badness, you could trigger angle-closure glaucoma)
21
Q
What is phenylephrine opth used for?
A
Adrenergic-stimulating mydriatic
Stimulates the pupillary dilator muscle
22
Q
What is tropicamide/cyclopentolate ophth used for?
A
Cholinergic-blocking mydriatic
Paralyzes the iris sphincter
23
Q
What test do you do when foreign body is suspected?
A
Eyelid eversion
24
Q
When you suspect the cornea might be scratched, what test should you do?
A
Fluorescein drops, then turn on the blacklight and have fun
25
What is strabismus?
Misalignment of the two eyes
26
What is phoria?
Tendency, not constant
Only evident with one eye covered
27
What is tropia?
Constant
Evident with both eyes open and uncovered
28
Phoria and tropia prefixes?
Eso - inward
Exo - outward
Hyper - upward
Hypo - downward
29
What is ectropion?
Outward turning of the lid
30
What is entropion?
Inward turning of the lid
31
Sxs for ectropion and entropion?
Irritation
Burning
Foreign body sensation
Tearing
32
Txt for ectropion and entropion?
Surgery to correct the lid abnormality
33
What is lagophthalmos?
Inability to completely close the eyes
34
Sxs of lagophthalmos?
```
Irritation
Burning
Foreign body sensation
Tearing
Failure of the “lacrimal pump”
```
35
Txt for lagophthalmos?
Mild:
Artificial tears, gels, ointments
Tape the eyes shut at bedtime
```
Moderate-Severe:
Suture lids (temporarily)
Gold weight surgically inserted into upper lid
```
36
Etiologies of ptosis?
Congenital - malformation of levator muscle
Acquired - thinning/detachment of levator aponeurosis
Horner Syndrome - small pupil, anhydrosis
CN-III palsy
Myasthenia gravis (ptosis may worsen with sustained upgaze)
37
Txt for ptosis:
If congenital, surgery to tighten or resect the levator muscle
38
What is blepharitis?
Scaling on the lid margins proximal to the lashes
39
Sxs of blepharitis?
```
Irritation
Burning
Foreign body sensation
Epiphoria
Photophobia
Intermittent blurred vision
```
40
What is epiphoria?
Excessive tearing
41
Txt for blepharitis?
Baby shampoo
Massage
ABX - erythromycin topical for staph
ABX - doxy PO if meibomian gland dysfunction
42
Hordeolum vs chalazion
Hordeolum (stye) PAIN
Chalazion NO PAIN (or minimally tender)
43
Describe hordeolum:
Painful nodule or pustule on the eyelid
External on skin surface or internal on conjunctival surface
Typically staph
Sebaceous gland involvement
44
Txt of hordeolum:
Warm compress
Lid massage
Consider topical erythromycin
Oral doxy if associated blepharitis
Surgical I and D if necessary (comes with risks like scarring, entropion/ectropion)
45
Describe chalazion
Blocked meibomian gland
Minimally tender or no pain
Firm, well-demarcated nodule below lid margin
Grayish discoloration on the conjunctival surface
46
Txt for chalazion?
Warm compress usually works (opens the gland up so it can be expressed)
Triamcinolone injection (steroid)(CI’d in dark-skinned patients)
If no resolution after 1 months, incision and curettage of meibomian gland
47
What is dacryocystitis?
Inflammation of the lacrimal sac
48
Txt for dacryocystitis?
Amoxicillin/clavulanate 500mg PO Q8H
Topicals can be used in addition to oral ABX
Warm compress and lid massage
If large, I and D
If chronic, dacryocystorhinostomy
49
Dacryocystitis vs dacryoadenitis?
Cyst = sac
Ade = gland
50
Dacryoadenitis:
Inflammation of the lacrimal gland
Sxs - lateral lid swelling, pain, tearing, swollen, tender, erythematous lacrimal gland
51
Txt for dacryoadenitis
If unclear, start with systemic ABX and reassess in 24 hrs
If infectious - amox/clav or ceph
If inflammation, steroids if idiopathic
52
MC lid carcinoma?
Basal cell
| Squamous is #2
53
Txt of basal or squamous lid carcinoma?
Surgical removal
Radiation therapy (if unwilling or unable to do surgery)
54
Sxs of viral conjunctivitis
Diffuse injection
Watery eyes
Follicular response (small dome-shaped lymphoid nodules)(no central blood vessel)
PREAURICULAR LYMPHADENOPATHY
Subepithelial infiltrates (immune response to viral antigens, causes decrease in vision/photosensitivity)
55
Viral conjunctivitis txt?
TELL PT HOW CONTAGIOUS THEY ARE
Typically self-limiting
Cold compress
Artificial tears
Steroid if pseudomembrane present
56
MC causes of bacterial conjunctivitis?
Staph
Strep
H. flu
BUT always consider gonorrhoeae, meningitidis, chlamydia (these go to ophth ASAP)
57
Sxs of bacterial conjunctivitis
Mucopurulent discharge
Redness
Irritation
Lid adhesion
58
Txt for bacterial conjunctivitis:
Trimethoprim/polymixin B QID x1wk
Fluoroquinolone QID x1wk (Besifloxacin, Moxifloxacin)
If neisseria or chlamydia - ceftriaxone 1gm IM, azithromycin 1g PO (admit and IV Cef if cornea involved)
59
Sxs of allergic conjunctivitis:
```
Intense itching
Watery discharge
Bilateral erythema and edema
Mild conjunctival injection
Chemosis
Conjunctival papillae (central blood vessel)
```
60
What is chemosis?
Swelling of the conjunctiva
61
Txt for allergic conjunctivitis?
Eliminate the allergen (duh)
Artificial tears
Topical antihistamine-mast cell stabilizer (Olopatadine)
If severe - Loteprednol (steroid)
Also, oral antihistamines (2nd gen)(Zyrtec, Allergra)
62
Questions to ask pt presenting with subconjunctival hemorrhage:
```
Previous episodes
Meds (ASA, coumadin, etc)
Trauma
Valsalva
Eye rubbing
Heavy lifting
Acute or chronic cough
Constipation
Bleeding or clotting problems
```
63
Workup for subconjunctival hemorrhage
```
IOP
BP check
Extraocular movement
PT/PTT (if recurrent)
CT if orbital signs present to r/o orbital mass
```
64
Txt for subconjunctival hemorrhage
Artificial tears if irritation present
D/C elective ASA
No txt req’d for the actual hemorrhage
65
Describe pinguecula and pterygium
A whitish-yellowish bump or fleshy “growth” on the exposed conjunctiva often in the 3 or 9 o’clock region of the eye
Highly vascularized
Think dry/sunny environments, chronic irritation 2/2 sunlight exposure
66
How to differentiate between pinguecula and pterygium
Pterygium invades the cornea, pinguecula does not
Just think pterygium has a “t”, and it “t”ouches the cornea
67
Txt for pinguecula or pterygium
Artificial tears as needed
Topical steroids if severe sxs
Surgical removal IF: pterygium interferes with sight OR pt experiences excessive irritation
68
What is a phlyctenule?
A nodular (lesion) growth at LIMBUS
Caused by hypersensitivity to bacterial proteins (staph, tuberculoprotein)
If unable to refer, txt with steroid-ABX combo (TobraDex or Zylet)
69
Txt for conjunctival laceration:
MUST R/O RUPTURED GLOBE
If under 1cm in length -> erythromycin ointment TID, monitor
If OVER 1cm in length -> surgical closure
70
Which type of corneal ulcers tend to be extremely painful?
Bacterial or fungal
They’re aggressive - can cause damage or blindness in 1-2 days
71
Sxs of HSV keratitis?
Irritation
Photophobia
Redness/conjunctival injection
Usually unilateral
EPITHELIAL DENDRITES (SEEN WITH FLUORESCEIN)
If advanced dz - scarring-vascularization
72
Txt for HSV keratitis
Refer
Topical antivirals
73
Should i use steroids for my HSV keratitis patient?
HELL NO - LEADS TO TISSUE LOSS, POSSIBLE OCULAR PERFORATION
74
Sxs of bacterial keratitis?
Ulceration of the epithelium
Increased anterior chamber reaction (with or without hypopyon)
Upper eyelid edema
Surrounding corneal inflammation
Conjunctival hyperemia
Mucopurulent discharge
75
Txt for bacterial keratitis:
Refer
Stain
AGGRESSIVE THERAPY
Topical fluoroquinolone
Fortified ABX if vision threatened (tobra or gent - alternate with cef or vanc)
76
Pseudomonas on the eye is commonly seen in:
Contact lens wearers
77
When would you suspect fungal keratitis? (Pt hx findings)
Recent hx of outdoor eye trauma with vegetative matter involved
Topical corticosteroid use
Cornea surgery
HSV
Contact lens use
78
Sxs of fungal keratitis
```
Foreign body sensation
Decrease in vision
Hypersensitivity to light
Conjunctival injection
Epithelial defect (FEATHERY WHITE/YELLOW OPACITY)
Anterior chamber reaction (hypopyon)
```
79
Txt for fungal keratitis
Refer
Surgical debridement - scrub that fungus off!
RX - Natamycin or amphotericin topical
RX - fluconazole or voriconazole PO
NO TOPICAL STEROIDS
80
When would topical steroids be appropriate for fungal keratitis?
They’re NOT
81
Corneal pigmentations are typically caused by:
Drugs
Chloroquines, hydroxychloroquine
Amiodarone
Indomethacin
Phenothiazines
82
Amiodarone can cause what ophthalmic condition?
Whorl-shaped pigmented deposits
83
Txt of corneal pigmentations?
Nada
It goes away when you stop taking the drug that caused it
84
What is recurrent corneal erosion?
After an injury, improper healing can lead to recurrent corneal erosion
85
Sxs of recurrent corneal erosion
Sharp pain typically upon awakening
Feels like eyelid is stuck to front of eye
86
Txt for recurrent corneal erosion
Refer
Hypertonic saline (prevents loosening)
Bandage contact lens if large
Oral analgesics PRN
Severe - laser surg
87
What is keratoconus?
Dz of unknown etiology
Progressive THINNING of the central cornea
Degenerative
Can cause myopia, astigmatism
Untreated -> perforation of the cornea
Can lead to scarring and blindess
88
What is Munson’s Sign?
Think KERATOCONUS
Bulging of the lower lids from thinning central cornea causing bulging of inferior cornea
89
Fleischer Ring is caused by:
Copper deposits
90
Features of episcleritis:
Mild pain
No discharge
Focal redness
Acute onset
Systemic symptoms
BLANCHES
91
Features of scleritis
SEVERE pain
No discharge
Focal or diffuse redness
Insidious onset
Systemic symptoms
DOES NOT BLANCH
92
Main difference between conjunctivitis and episcleritis/scleritis?
Conjunctivitis has discharge, the other two do not
Also, conjunctivitis usually doesn’t have systemic sxs, while the other two do
93
Causes of episcleritis
Usually idiopathic
Or
Herpes, RA, SLE, rosacea, thyroid dz, syphilis
Usually young adults
94
Workup for episcleritis:
Good hx - ask about rashes, arthritis, STD’s
External exam will show absence of bluish hue (scleritis has the bluish hue, there’s another differentiator for ya)
After you apply phenylephrine topically, the vessels blanch
95
Txt for episcleritis?
Refer
Typically self-limited
Cold compress
Artificial tears
If mod-severe -> topical steroids (fluorometholone), NSAIDs
96
Describe scleritis
SEVERE, BORING PAIN (prominent feature)(radiating to the jaw, forehead, or brow)
Inflammation (focal or diffuse)
Photophobia
Tearing
BLUISH HUE
97
What must the workup for scleritis include?
Actual medicine stuff - skin/joints, CV, respiratory, shotgun labs
98
Txt of scleritis?
H2RAs (i.e. Zantac)
Ibuprofen
If no improvement, systemic steroids
Immunosuppresive therapy
If necrotizing, add lubrication and scleral patch graft may be necessary
99
Txt for posterior scleritis?
Controversial
Cyclophosphamide
Rituximab
Glucocorticoids
....controversial therapies = probably not on the test (just my guess, before you try and memorize this)
100
Anterior uveitis is AKA:
Iritis or iridocyclitis
101
What is anterior uveitis?
Inflammation of the iris and iris-ciliary body
Associated risk factors: HLA-B27 (+), JA, infection, malignancy, trauma
102
Sxs of anterior uveitis?
Can be either acute or insidious, unilateral or bilateral
Redness
Photophobia
Ciliary injection
Keratic precipitates (fine and whitish = nongranulomatous, “mutton fat” = granulomatous)
Floating cells
Hypopyon
Irregular pupil shape
On iris - Koeppe nodules and Busacca nodules
103
Anterior uveitis workup:
H and P
R/o systemic causes
Shotgun labs (especially if bilat)
104
Txt for anterior uveitis?
Refer
Topical - predinsolone
Cycloplegic - Scopolamine
If severe -> atropine
105
Prognosis for anterior uveitis?
First time, nongranulomatous = excellent
Recurrent granulomatous = poor
106
Sxs posterior uveitis:
Either acute or insidious, unilateral or bilateral
Decreased vision
Floaters
Occasional redness and pain
Optic disc swelling with edema
Retinal/choroid hemorrhages
107
Txt of posterior uveitis?
Refer
Topical cycloplegic if anterior involvement
Topical steroid if anterior involvement
Treat the underlying cause
108
Risk factors for cataracts?
```
Age
Diabetes
Trauma
Toxins
Inflammation
Radiation
Tumor
Degenerative dz
```
109
Nuclear cataracts:
Usually age-related
Yellow or brown discoloration of central part
Blurs distant vision more than near vision
110
Posterior subcapsular cataracts
Opacities near posterior aspect of lens
Glare and difficulty reading
DM, trauma, radiation, inflammation
111
Cortical cataracts
Spokelike opacities
Often asymptomatic (until develops centrally)
112
Sxs of congenital cataract:
Mild-severe decrease in vision
Infants may keep eyes closed or squint
Leukocoria
Absent or diminished red reflex
113
Txt of congenital cataract:
This is an EMERGENCY
Untreated can lead to IRREVERSIBLE amblyopia
So....you know...fix it
114
MC cause of lens dislocation?
Trauma
Other causes: Marfan, homocystinuria, syphilis
Results in subluxation of the lens (25% of zonular fibers ruptured)
115
What are “floaters”?
```
Dookies that float
.
.
.
.
.
.
.
.
.
.
.
.
.
.
But, for eye folks, they’re: small aggregates of protein in the vitreous cavity that cause visual anomalies
```
116
Causes of acute floaters?
Uveitis
Bleeding into the vitreous (DM, sickle cell)
Posterior vitreous detachment
Retinal tear
117
Flashers suggest:
Traction of the vitreous on the peripheral retina
May occur during the evolution of a posterior vitreous detachment or as the vitreous pull on a tear in the retina
Flashers can also happen with migraines
118
Risk factors for vitreous detachment
DM retinopathy
Trauma
Cataract surgery
119
What is a Weiss Ring?
Seen with vitreous detachment
120
Sxs of vitreous detachment
Sudden appearance of black spots or flashing lights
Pt complains of floaters
121
Txt for vitreous detachment
Refer
Txt the problem
If retinal break/tear/detachment -> photocoagulation or cryotherapy may be necessary
122
Where is the optic nerve seen?
On the nasal side (medial)
Macula is lateral
123
Appx size of optic nerve?
1.5mm diameter
124
How do arteries appear?
Thinner, more orange/red
125
How do veins appear?
Thicker, darker (more crimson)
126
Normal AV ratio:
2:3
127
Veins and arteries travel together, meaning:
Veins to do not cross veins
Arteries do not cross arteries
128
What does the central retinal artery supply?
The INNER RETINA (towards center of eye)
Remember CENTRAL-INNER
129
What does the choroid supply?
The OUTER retina (towards the outer wall)
Supplies the photo receptors
High O2 demand
130
The retina is mostly:
Transparent tissue
131
Sxs of retinal artery occlusion
Unilateral acute vision loss
Afferent pupillary defect
Painless
Happens over seconds
MARKED opacification or whitening of the retina
CHERRY RED spot in the center of the macula (the fovea)
Box-car (segmentation in arterioles)
132
Workup for retinal artery occlusion?
IMMEDIATE ESR (giant cell arthritis)
Full dilated exam
BP check
SBG, CBC, Lipids, A1C, PT/PTT, RF
US of carotid artery
Cardiac exam
133
Txt of retinal artery occlusion
No proven effective treatment
Goals: decrease ocular pressure, disrupt/break the occlusion
Ocular massage, anterior chamber paracentesis, Acetazolamide PO, Timolol topical
HIGH DOSE STEROIDS if it’s giant cell arteritis
134
Retinal vein occlusion sxs
Painless, unilateral vision loss
Afferent pupillary defect possible
“Blood and Thunder” fundus
Flame-shaped hemorrhage
*this is the most metal description of an eye issue i’ve ever seen, btw...
Cotton wool spots and exudates
135
Workup for retinal vein occlusion?
Complete ocular exam
IOP measurement
Angiography
Systemic hx
136
How will the presence of an afferent pupillary defect help you differentiate ischemic from non-ischemic retinal vein occlusion?
APD will be present with ischemic retinal vein occlusion
If it’s non-ischemic, no APD
137
Txt of retinal vein occlusion?
Mandatory full ophth evaluation
Discontinue OCPs
Reduce IOP if increased
Txt the underlying cause
If neovascularization, PRP
Once daily ASA (rx’d often but no evidence that is works)
138
MC cause of legal blindness age 60+?
Age Related Macular Degeneration (ARMD)
139
What are the two main types of ARMD?
Nonexudative (dry)
Exudative (wet)
140
What is MC abnormality seen with ARMD?
Drusen (yellowish deposits deep in the retina - looks like speckles around the macula)
Limits the nutritional support to the outer retina
141
Sxs of dry ARMD
Gradual loss of central vision
Macular drusen
Clumps of pigment on the outer retina
142
Sxs of wet ARMD?
Distortion of straight-line edges
Rapid onset visual loss
Drusen
Choroidal neovascularization
Subretinal hemorrhages
143
What is Amsler grid testing used for?
ARMD
It documents the degree of central field loss
Performed daily during follow up period
144
When is IV fluorescein angiography performed?
If sub-retinal neovascularization membrane is present or suspected
145
Txt for dry ARMD?
High-dose vitamin C, E, beta-carotene, and zinc
NO BETA CAROTENE FOR SMOKERS
146
Txt for wet ARMD?
Laser photocoagulation, performed within 72hrs of angiography
147
What are the three different types of retinal detachment?
1. Rhegmatogenous - vitreous separates from retina, causing break of tear, the liquified vitreous dissects the retina
2. Exudative - leakage without a break, usually from something (i.e. tumor) below the retinal layer
3. Traction - with proliferative diabetic retinopathy
148
Pt has flashers and floaters - must r/o:
Retinal detachment
149
Sxs of retinal detachment
Flashes and floaters
“Curtain or shade” pulled down over eyes
Decreased vision
Visual field loss
Metamorphopsia (wavy, distorted vision)
“Ripples on a pond”
150
Workup for retinal detachment
Complete ocular exam
Difficult to dx with direct ophthalmoscopy alone
Eye with detachment will have a lighter red reflex
151
Txt for retinal detachment
Refer
Rest
Expeditious surgery
152
I’m calling in sick because i’m having an eye problem.
Eye cant see myself coming in to work today
