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Senior - Ophthalmology > Review Deck 98-184 > Flashcards

Review Deck 98-184 Flashcards

1
Q

Definition of glaucoma?

A

Group of diseases w progressive

  • optic nerve damage
  • visual field loss
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2
Q

2 categories of glaucoma?

A

Open angle glaucoma
- most common
Angle-closure glaucoma

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3
Q

Difference between open angle and closed angle glaucoma?

A

Open angle glaucoma
- blockage of aqueous outflow

Angle closure glaucoma
- structurally normal outflow pathway

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4
Q

Risk factors for open-angle glaucoma?

A 
Increased age
AA
Family hx
DM
Systemic HTN
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5
Q

AAO risk factor weighting?

A

Charty thing that calculates the level of glaucoma risk

See slide 100

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6
Q

Clinical tests for open-angle claucoma?

A

IOP (may be normal)
Pupillary examination (crescent shadow)
Opthalmoscopy (cup-disk >0.6)

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7
Q

If you suspect POAG?

A

Ophthalmology referral

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8
Q

Treatment approach for lowering IOP?

A

Decreasing production of aqueous fluid

  • B-blocker
  • a2- agonist
  • carbonic anhydrase inhibitors

Increasing outflow of aqueous

  • less-selective sympathomimetics
  • prostaglandins analogs
  • miotic agents
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9
Q

Open angle glaucom meds

A

Chart slide 103

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10
Q

B adrenergic blocker side effects?

A

Decreased CO

Bronchoconstriction (NO COPD/asthma)

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11
Q

Alpha 2 adrenergic agonist SE?

A

Allergic conjunctivitis

Contact dermatitis

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12
Q

Less-selective sympathomimetics SE?

A

Exacerbation of hypertension

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13
Q

Prostaglandin analogs SE?

A

Conjunctival hyperemia

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14
Q

Who gets surgery for open angle?

A

If the optic neropathy worsens

Younger ps

Noncompliant pts

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15
Q

What is a trabeculoplasty?

A

Therapy using

  • Argon laser
  • Selective laser
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16
Q

What is a trabeculectomy?

A

Implant/shunt surgery

Aqueous fluid flows into subconjunctival space (filling bleb)

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17
Q

What is ciliary body ablation?

A

Destroys a portion of the ciliary epithelium

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18
Q

Symptoms of acute angle glaucoma?

A 
Blurred vision (unilateral)
Monocular halos 
Eye pain/photophobia
Frontal HA
Vasovagal symptoms
N/V
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19
Q

Signs of acute angle closure glaucoma?

A 
Mid-dilated pupil
Conjunctival injection
Lid edema
Corneal edema w blurring of light reflex
Elevated IOP (60-80mmHg)
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20
Q

What are the risk factors for acute angle-closure glaucoma?

A 
Women 4x more
55-70 yrs
Short, small, far-sighted eyes
Extreme dilation
Drugs 
- anticholinergics
- sympathomimetics
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21
Q

Treatment of choice for acute angle-closure glaucoma?

A

Laser iridotomy (post attack)

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22
Q

Meds for acute angle closure glaucoma?

A

Timolol (aqueous fluid)
Acetazolamide IV
Isosorbide IV
Mannitol IV

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23
Q

Chronic angle-closure glaucoma signs and symptoms?

A 
Asymptomatic (usually)
Decreased vision/field loss
Elevated IOP
Broad bands of PAS
Optic nerve damage

Normal Pupil

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24
Q

How are broad band PAS diagnosed?

A

With a gonioscopy

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25
Surgical Tx for chronic angle-closure glaucoma?
``` Surgical - goniosynechialysis — strip the PAS - iridotomy — allow drainage ``` PAS = Peripheral anterior synechiae (PAS) are adhesions of the peripheral iris to the structures in the angle of the anterior chamber.
26
Medical Tx for congenital glaucoma?
Topical levobunolol or timolol Oral acetazolamide
27
Surgical treatment for congenital glaucoma?
Goiniotomy (trabecular meshwork) Trabeculotomy Trabeculectomy
28
What is the medical tx used for with congenital glaucoma?
Its temporary measure to hold them until they can get surgery We dont want kids to have to use drops for their entire life
29
S/s of neovascular glaucoma?
``` Asymptomatic (sometimes) Pain Red eye Photophobia Decreased vision ```
30
Treatment for neovascular glaucoma?
Timolol Glaucoma filtration Surgery
31
Steroids and glaucoma?
Prolonged use of steroids can cause reduction of outflow facility of trabecular meshwork
32
What types of steroids cause steroid response glaucoma?
High-dose skin creams Inhalers
33
Treatment for steroid response glaucoma?
DC steroid Decrease steroid dose Add anti-glaucoma therapy
34
There are lots of types of glaucoma (technically its anything that plugs up the flow in the eye) What other types are there?
Inflammatory open-angle glaucoma Exfoliative glaucoma Phacolytic glaucoma Postoperative glaucoma LTG or normal tension glaucoma
35
Diagnosis of glaucoma requires?
Progressive optic nerve damage Progressive visual field loss
36
Without progressive optic nerve damage and visual field loss the pt just has?
Ocular hypertension
37
What is hemianopia?
Loss of an entire half of the visual field
38
What is hymonymous hemianopia?
Visual field loss on the same side in both eyes
39
What isis ipsilateral hemianopa?
Visual field loss is on the same side the lesion is on
40
What is contralateral hemianopia/?
Visual field loss on the opposite side of the lesion
41
What is scotoma?
An area of reduced or absent vision within an otherwise intact visual field
42
What is anisocoria?
Unequal size of the pupils >1mm
43
Visual field pathway?
Slides 117 and 118, prob worth a look
44
What is the afferent pathway?
CNII Light travels up CNII, divides in the chiasm Arrive at pretectal nucleus cross end and EW nuclei
45
What is the efferent pathway?
CN III Signal sent from EW nuclei down the oculomotor nerve (CNIII) The pupils constrict
46
If i tell you that the visual pathway has double decussation you are smart and know that this means ...?
It first decussates t the chiasm Second is at the prectal nuclei to the endinger-westphal nuclei
47
What is responsible for the direct/consensual response?
The double decussation
48
How does neurosyphilis present?
Its damage to the cenral pupil pathway so it causes Argyll Robertson pupil
49
Argyle robertsons pupil is aka? Describe it
Prostitue’s pupil The pupil is small Responds slowly/not at all to light But Response to near accommodation I.e. it accommodates but doesnt react
50
Contrasted with argyle robertson’s pupil adie’s tonic pupil is?
Idiopathic and benign
51
Signs of adie’s tonic pupil?
Dilated pupil Reacts poorly to light Reacts better to accomidation Its “sluggish and tonic”
52
Who gets adie’s pupil?
Women
53
What non optho sign is seen with adie’s pupil?
Loss of DTR’s
54
Adie’s pupil does not have?
Abnormal extra-ocular movements Ptosis This are signs of CN III palsy
55
Causes of adies tonic pupil?
Idiopathic Viral etiology Inflammatory process
56
How to confirm adie’s pupil?
Give 0.125 pilocarpine Adie’s pupils will constrict Normal will not constrict
57
What causes horner’s syndrome (30,000’)
Injury to the sympathetic nerves of the face
58
Sings of horner’s syndrome?
``` Ptosis Pupillary miosis (constricted) Facial anhydrosis (lack of sweating) ```
59
What are some common causes of horner’s?
``` Stroke of brainstem Injury to carotid artery Tumor in lung Cluster HA Congenital ```
60
Diagnosis of horner’s?
10% cocaine - dilates normal pupil - no dilation in horner’s Horner doesnt do cocaine
61
What happens during the swinging flashlight test if the pt has marcus gunn pupil?
When light is shone in the affected eye the pupils dilate bc the brain never receives the signal
62
Papilledema must be?
Bilateral
63
Causes of papilledema?
Intracranial mass Impediment of CSF flow Idiopathic intracranial hypertension
64
Symptoms of papilledema?
``` HA N/V Transient vision loss Pulsatile tinnitus Horizontal diplopia ``` Secondary to intracranial mass
65
Signs of papilledema?
``` Optic disk edema Blind spot Visual field/acuity loss (chronic) Pseudotumor cerebri Sixth nerve palsy ```
66
If you suspect papilledema you should order?
BP (1st step) MRI w contrast Lumbar puncture (pressure) Neuro consult Opthalmology consult
67
Tx for papilledema involves?
Treating the underlying disease
68
Tx fo pseudotumor cerebri?
Wt loss Acetazolamide Furosemide Neurosurgical shunt
69
What is ischemic optic neuropathy?
Papillitis (optic disk swelling)
70
What causes ischemic optic neuropathy?
Atherosclerotic/thrombic occlusion Hemodynamic compromise
71
Sudden painless vision loss, usually upon waking you need to suspect?
Ischemic optic neuropathy
72
Types of ischemic optic neuropathy?
Arteritic AION Non-arteritic NAION
73
Pt population for ischemic optic neuropathy?
>60 AION-GCA | Middle age NAION
74
S/S of ischemic optic neuropathy?
Unilateral swollen optic disc (initially) - progresses to bilateral Flame shaped hemorrhages Optic disc pallor
75
Blood work for ION present?
Vasculitis - Westergren ESR - CRP Anemia DM
76
Who gets neuroimaging?
Uncertain or progressive cases
77
Treatment for ischemic optic neuropathy? Hint its different based on the type
NAION: (8 weeks) - observation - aspirin AION: - systemic steroids — (methylprednisolone then prednisone) -temporal artery biopsy
78
What causes optic neuritis?
Demyelination of the optic nerve - idiopathic - MS - postviral origin
79
Symptoms of optic neuritis?
Unilateral vision loss - over hours - days Orbital pain (w movement) Transient neuro disturbances
80
Cure for optic neuritis?
I dont know pray to the universe or god or cheese burgers, doesnt matter b/c it has spontaneous recover
81
Age for optic neuritis?
18-45yrs
82
Signs of optic neuritis?
``` Disk edema (only 1/3 of pts) Central visual field loss Relative pupillary defect ``` Decreased color vision
83
Workup for optic neuritis?
Opthalmic eval MRI w contrast Non-diagnostic labs - CBC - CXR - electrolytes
84
Tx for optic neuritis
MRI found 1 area - pulsed IV steroid - no long term change in vision MRI found 2+ - interferon No lesions: - IV steroids
85
When treating optic neuritis you should not?
Start therapy w oral steroids There is an increased recurrence rate
86
CN III palsy effects?
The oculomotor nerve - extraocular muscles (SR, IR, IO, MR) - levator palpebrae - pupillary sphincter
87
Etiology of CN III palsy?
``` Vasculopathic - DM - HTN Trauma Compression - aneurysm - tumor ```
88
CNIII s/s?
``` Ptosis Diplopia (turned down and out) HA or periorbital pain Deficiencies in eye movement Dilated pupils ```
89
Dialed pupil with CN III palsy?
This is a bad sign Stat MIR to r/o aneurysm
90
Besides blown pupil who else gets MRI?
Pts without obvious vascular risk factors
91
Who gets a cerebral angiography?
Suspected aneurysm
92
When do pts only need observation?
When there is no evidence of vasculitis Pupil is spared
93
Tx for CN III palsy?
Fix the underlying etiology
94
S/s of 4th nerve palsy?
Vertical/oblique diplopia Objects appear tilted Pt tilts head Eyes dont depress well when adducted (Dont look as far down)
95
Workup for CN IV palsy?
MRI if <45 Opthalmic evaluation - ocular alignment
96
Tx for CN IV palsy?
Treat the underlying disorder Glasses
97
S/S of CN VI palsy?
- Horizontal diplopia - HA - periorbital pain - esotropia - abduction deficit - head turn position — minimize the diplopia
98
Workup for CN VI palsy?
opthalmic eval MRI
99
Leading cause of blindness for ages 20-64?
DM
100
2 classifications of DM retinopathy?
Non-proliferative diabetic retinopathy - hemorrhages, - microaneurisms, - exudates Proliferative diabetic retinopathy - new blood vessels grow
101
When does vision loss appear with Diabetic retinopathy?
Late stage of proliferative diabetic retinopathy
102
Neovascularization comes from proliferative diabetic retinopathy, what causes this?
The ischemia - compromised perfusion = angiogenic factor release - stimulates growth of new vessels
103
MC place for neovascularization to occur?
Vascular arcades
104
Signs of proliferative diabetic retinopathy?
``` Fine lacy blood vessels seen on: - optic nerve - retina - iris Pre retnal hemorrhages Cotton wool spots Dot and blot intra-retinal hemorrhages Loss of red reflex Floaters ```
105
What are pre-retinal hemorrhages?
Boat shaped hemorrhages that are anterior to retinal vessels
106
Tx for proliferative diabetic retinopathy?
Tight glycemic control If neovascular changes then send to optho - pan retinal photocoagulation (PRP)
107
Earliest signs of diabetic eye problems?
Diabetic macular edema - micro-aneurysms — increased permeability Vascular endothelium “tight junctions”
108
What is hypertensive retinopathy? Hallmark?
Changes from chronicity of hyptertension | - hallmark is diffuse arterolar narrowing
109
What changes are made by chronic hyptertension?
``` Thickening of vascular wall Cocominant narrowing of vessel lumen A:V ratio changes Copper-wire vessel - Yellowing of the linear light reflex Silver wire - sclerosis of the vessel ```
110
How does giant cell arteritis cause vision problems?
Vision loss is secondary to vasculitic occlusion specifically to the arteries of the optic disk
111
Symptoms of giant cell arteritis?
EXTREME sudden vision loss HA SCALP AND TEMPLE TENDERNESS And some other common constitutional symptoms
112
Signs for giant cell aerteritis?
- 60’s - pale optic disc swelling - temporal arteries are: — firm — tender — pulsless - esr >50 - mild anemia - 3,4,6th nerve palsy - relative afferent pupillary defect
113
What bloodwork needs to be done immediately?
ESR Then do a biopsy and chem panel etc
114
Tx for giant cell?
IV methylprednisolone 250mg iv q 6hrs x 72hrs Then Prednisone 80-100mg po qd
115
What is myasthenia gravis?
Autoimmune disorder of the NMJ It improves w rest, worsens w activity Causes lots of muscle weakness
116
Signs of mysanthenia gravis?
Ocular motility measurements vary Variable ptosis Fatigue w sustained upgaze
117
How can you test for MG?
Edrophonium chloride (tensilon) test Ice test - over eyes x 2 min - if ptosis gets better its positive test
118
Tx for MG?
``` Alternate eye occlusions Pyridostigmine Low dose prednisone Thymectomy Azathioprine (immunosuppressant) ```
119
Symptoms of thyroid disease; mild, moderate, severe
Mild - irritation - foreign body sensation - burning - tearing Moderate - double visoni - blurred vision - ache Severe - vision loss - corneal ulcerations
120
Signs of thyroid disease?
- Bilateral - proptosis/exophthalmos - lid retraction - lagophythalmos - exophthalmos - restricted ocular motility - swollen conjunctiva/lids/brow - loss of visual acuity/visual fields
121
What will you see on CT with thyroid disease?
Muscle thickening in the orbit | - causes the eyes to bulge out
122
Tx of eye problems from thyroid?
Moderate-severe - oral prednisone - orbital decompression - repair of lid retraction - orbital radiation - strabismus surgery
123
Common vision symptoms of aids patients?
Floaters Blurred/decreased vision Blind spots Flashes (retinal detachment)
124
Signs found in HIV/AIDS pts?
Cotton wool spots (MC) Keratic precipates (stellate shaped) Vitreous cells Hemorrhages
125
HIV tx?
IV ganciclovir IV foscarnet Or a combo of these
126
RA S/S in the eyes?
- foreign body sensation - corneal ulcer - anterior uveitis - necrotizing scleritis - scleral thinning (scleromalacia)
127
Difference between necrotizing scleritis and scleromalacia?
Necrotizing scleritis - painful Scleral thinning - slow and painless - minimal inflammation
128
Never give RA ____
Topical steroids
129
2 MC eye cancers?
Basal cell carcinoma - MC eye malignancy Squamous cell carcinoma - MC conjunctival malignancy
130
Other rare eye cancers?
Malignant melanoma Astrocytoma Retinoblastoma (kids)
131
Signs of wilson’s disease?
Kayser-fleischer ring - brown red deposit on cornea Sunflower cataract - subcapsular copper deposit
132
3 MC drugs that cause ocular effects?
LSD (just kidding) 1. Amiodarone 2. Chloroquine 3. Corticosteroids Chart on slide 163
133
Preseptal cellulitis vs orbital cellulitis?
Preseptal cellulitis - inflammation/infection of eyelid - doesnt go past orbital septum Orbital cellulitis - gets into the orbit - emergency
134
With preseptal cellulitis you will not see:
NO proptosis NO restricted ocular motility NO pain w eye movement NO optic neuropathy
135
Signs/symptoms of orbital cellulitis
Signs: - fever - WBC - PROPTOSIS - RESTRICTED OCULAR MOTILITY - pain w movement Symptoms - pain - diplopia - warm tender etc - periorbital swelling
136
Tx for orbital cellulitis?
Admit Iv abx Erythromycin ointment Surgical drainage
137
How to examine for corneal abrasions?
A slit lamp exam - anestetic - fluorsecein stain - examine anterior chamber - Examine for corneal laceration/penetrating trauma Evert the eyelid and look for FB
138
Tx for corneal abrasions
Topical abx: polymyxinB or fluoroquinolong Cycloplegic agent - traumatic iritis Eye patching
139
Never eye patch an abrasion if?
Vegetative matter/fingernails are involved Pt wears contact lease Just give floroquinolone
140
Workup for contact lens irritation?
Eye exam Slit lamp Fluorscein stain Eversion of lid
141
Tx for contact lens irritation?
General: - remove x 14 days W abrasion - Gm Neg coverage - pseudomonas - referral
142
Eye drugs for pseudomonas?
Fortified gentamicin or fortified tobramycin And Fortified cefazolin or vancomycin Alternate drops q 30 min Fortified just means they had to compound it b/c its not available in eye drops normally
143
Every pt with corneal foreign body gets?
Visual acuity Bilateral eye exam IOP Slit lamp
144
What should you do for a “high speed” corneal foreign body?
CT Scan
145
Tx for foreign body of cornea?
Globe penetration : PUNT Superficial - anesthesia and remove - remove rust ring - topical abx
146
Intraocular foreign body treatment?
Protective shield on eye while you get them to the hospital Tetanus shot
147
What will opthomology do for an intraocular FB?
vancomycin Cycloplegic - accommodation and pain mgment Surgical removal
148
What is ultraviolet keratitis?
Basically a sunburn of the eyeball - welding - sunlamp - snow - drugs (maybe)
149
Tx of ultraviolet keratitis?
Cycloplegic agents Abx ointments Patching Oral analgesics
150
The workup for chemical injury?
Conducted after you flush the eyes x 30 min
151
Tx for chem injury?
First flush ``` Cycloplegic agents (scopolamine) Topical abx (erythromycin) Oral pain meds IOP control PRN Artificial tears PRN ```
152
What is hyphema?
Blood in the anterior chamber - severe trauma
153
When could you see spontaneous hyphema?
Retinoblastoma Leukemia Clotting disorder Spontaneous in child (child abuse)
154
Tx for hyphema?
Optho consult is MANDATORY - Bed rest w head elevated - shield eye (clear not patch) - cycloplegic agent bid — atropine, scopolamine - analgesia/anti-emetics prn NO NSAIDS or ASPIRIN
155
What is a blow out fracture?
An orbital blowout fracture is a traumatic deformity of the orbital floor or medial wall, typically resulting from impact of a blunt object larger than the orbital aperture
156
Workup for blow out fracture?
Evaluate - EOM’s - r/o rupture globe - eyelid crepitus - measure IOP - retina for artery occlusion/optic nerve Monitor visual changes CT scan
157
Tx for blow out fx?
Referral to optho Nasal decongestant Abx (cephalexin) Ice
158
Workup for lid laceration?
Examine both eyes - dilate - r/o optic nerve injury - r/o ruptured globe Eval canalicular and lacrimal system CT scan if globe involvement Evaluate ptosis
159
Tx for lid laceration:
Tetanus shot Oral abx Referral
160
Referral conditions for lid laceration?
``` Involves canalicular system Rupture globe Intraoccular FB Involves levator (ptosis present) Visible orbital fat Extensive tissue loss (1/3 of lid) ```
161
Why did the phone wear glasses?
Because it lost all its contacts

Senior - Ophthalmology (3 decks)

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