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RRCCPA ClinMed > RRCC Ophthalmology Pt I II and III > Flashcards

RRCC Ophthalmology Pt I II and III Flashcards

1
Q

Where do tears come from?

A

lacrimal gland

Muscous glands scattered throughout conjunctiva produce mucous which mixes watery portion to create protective film

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2
Q

Where do tears drain?

A

Upper and lower puncta. Move into short canal called canaliculus to the nasolacrimal duct into the nose.

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3
Q

Function of the iris

A

Thin circular structure of the eye responsible for controlling the diameter and size of the pupil and amount of light reaching the retina

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4
Q

Function of pupil and associated muscles/innervations

A

dilates and contricts to allow more or less light to the retina.

Dilator pupillae innervated by sympathetic system (CN V1 branch of optic nerve)

sphincter pupillae (constrict) parasympathetic system (CNIII)

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5
Q

Conjunctiva

A

the mucous membrane that covers the front of the eye and lines the inside of eyelids.

Contains blood vessels

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6
Q

Aqueous humor

  1. Where produced?
  2. What does it flow through/ reabsorb?
A
  1. Produced by ciliary body by diffusion and active transport plasma
  2. flows through the pupil and fills the anterior chamber. Reabsorbs by trabeculae in the canal of schlemm
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7
Q

Function of cornea

A

transparent portion over the iris and pupil that protects the structures and help to transfer and focus light on the retina.

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8
Q

Viterous chamber

A

space b/w the lens and the retina that is filled with clear gelatinous material (vitreous humor)

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9
Q

Retina

A

thin layer of tissue that lines the back of the eye and contains photoreceptors and blood vessels to nourish them

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10
Q

What are cones and rods

A

photoreceptors

Cones are responsible for sharp, detailed central and color vision. Found in the macula

rods are responsible for night and peripheral vision

There are more rods than cones

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11
Q

What forms the blind spot?

A

optic nerve exits the back of the eye through the optic disk. Since no receptor cells are located in this region, it forms a blind spot in the visual image of the external world. This blind spot is easily compensated for by primary visual cortex with information obtained from the opposite eye.

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12
Q

Function of the levator palpebrae

A

Keeps eye open

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13
Q

Rule of thumb:

eye= which CN?

A

CN III

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14
Q

Anterior Blepharitis

  1. Name with viral and bacterial causes
  2. Tx
A

inflamm of eyelids. Bilateral if lid margins

  1. Causes: S. aureus or S. epidermititis (viral-dry scales, redness of lid margins, irritation, burning, itching)

seborrheic (bacterial- greasy scales, burning, itching)

  1. Keep eyelids clean, remove scales with hot wash cloth/baby shampoo.

Antistaph abx or Sulfonamide eye ointment

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15
Q

Posterior Blepharitis

1 dx

  1. tx
A
  1. chronic bilateral inflamm of eyelids secondary to dysfunction of the Meibomian glands

Strong association with acne rosacia

Hyperemic lid margins with telangiectasias (dilated small blood v.)

  1. Abx may be needed in more chronic cases
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16
Q

External Hordeolum

  1. define
  2. sx/sxs
  3. tx
A
  1. Staph infection

Stye: small and on the margin, ACUTE

  1. localized redness/swelling/acute tenderness involving the upper/lower lid
  2. warm compress, wash eyelid 4x/day. Incision may be needed it may lead to general cellulitis and requires immediate medical attention
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17
Q

Internal Hordeolum

  1. Define
  2. sx/sxs
  3. Tx
A
  1. Staph infxn
    chalazion: meibomian gland abscess usually points to conjunctival surface of the lid. CHRONIC
  2. localized redness/swelling/acute tenderness involving the upper/lower lid
  3. Warm compress/wash 4x/day/incision may be needed. Steroid inj may be used (refer to optho)
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18
Q

Entropion vs Ectropion

A

Entropion- inward turning of eyelid. Common in elderly lose elasticity. Surgery if lashes cause corneal irritation

Ectropion- outward turning of eyelid. Surgery if excessive dryness, keratitis, exposure problematic.

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19
Q

Pinguecula

A

Yellowish, slightly raised conjunctival lesion and remains confined to the conjunctiva. Often arise from temporal conj.

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20
Q

Pterygium

  1. Findings
  2. tx
A

Triangular wedge of fibrovascular conjunctival tissue that starts medially on nasal conj and extends laterally onto cornea.

  1. artificial tears for dryness. Surgery considered for large lesions impacting visual acuity, but high risk of recurrence. Not to be confused with Pinguecula.
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21
Q

Different types of tumors

A

Basal cell/ squamous cell/ meibomian gland/ malignant melanoma

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22
Q

Dacryocystitis

A

accute inflamm of the lacrimal sac usually due to congenital or acquired obstruction of nasolacrimal system (supratemporal region)

Common in kids

F>M

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23
Q

Dacryocystitis

acute vs chronic

  1. Sx/sxs
  2. Causes
A

Acute- erythema, swelling, warmth, tenderness of the lacrimal duct and/or purulent discharge. Cause: alpha-hemolytic streptococci, S. epidermis, S. aureus

chronic-epiphora, mucopurulent drainage, +/- decreased visual acuity

cause: S. epidermidis, gram-neg bacilli

24
Q

Dacryocystitis

Acute vs chronic

  1. tx
A

acute- abx, surgery (may be done in urgent cases), warm compress

Chronic- consider surgery for relief

25
Q

Conjunctivitis

mode of transmission

A

most common eye disease

most common viral (bacterial, allergies also possible)

Mode of transmitiion- direct contact with fingers, towels, contaminated drops

26
Q

Acute conjunctivitis

Discharge?

Vision?

Pain?

Cornea/pupil/IOP?

A

moderate to copious discharge (white-bacterial, clear-viral, clear/itchy-allergy)

no effect of vision

pain-mild

cornea- clear

injection-diffuse, more toward fornices

Pupil size/ light response/ IOP: normal

27
Q

Viral conjunctivitis

  1. MC cause
  2. Sx/sxs
  3. tx
A
  1. MC cause- adenovirus

other causes: HSV

  1. bilateral, hyperimia of conjunctiva, watery discharge, foreign body sensation
  2. Cool compress/ NO patch
28
Q

Bacterial conjunctivitis (pink eye)

  1. cause
  2. sx/sxs
  3. tx
A
  1. staph, MRSA, pseudomonas (contact lens), gonococcal (EMERGENCY), chlamydia (major cause of blindness)
  2. significant purulent drainage, mild discomfort, no blurring of vision, hyperimia
  3. abx, topical abx, very contagious.
29
Q

Corneal abrasion

  1. Define
  2. Sx/sxs
A
  1. traumatic erosion of the corneal surface caused by trauma (fingernail, eyelash) or contact lens wear
  2. Mild-severe pain. tearing. photophobia. foreign body sensation. blepharospasm (eye twitch)
30
Q

Corneal abrasion

  1. eval
  2. tx
A
  1. IVVEP.

Visual acuity, lid eversion, fluorescein staining are the MUSTS!

  1. Saline irrigation after the assesment (can use topical anesthetic but may not rx to avoid delayed healing)

abx ointment

daily f/u

31
Q

Corneal ulcers

  1. Cause
  2. sx/sxs
  3. risk factors
A
  1. May result from inflamm or infxn (viral/bacterial)
  2. Pain, photophobia, tearing, no vision acuity changes unless central. Generally no change in visual acuity
  3. trauma, CONATCTS*, poor lid adiposition
32
Q

Bacterial Keratitis

  1. MC pathogens
  2. Risk factors
  3. Findings
  4. Tx
A
  1. inflamm of the cornea caused by Pseudomonas, Staph (including MRSA), Streptococci
  2. contact lenses, corneal trauma, refractive surgery
  3. cornea is hazy, with an ulcer and adjacent stromal abscess. (angry eye)
  4. EMERGENT optho. Culture/gram stain.
33
Q

Cataracts

  1. Define
  2. Risk factors
A
  1. lens opacification- MCC of blindness (reversible w/ surgery)
  2. Older age, trauma, systemic disease, smoking, UV exposure
34
Q

Cataracts

  1. Clinical feature
  2. PE findings
A
  1. blurry vision, excess glare, fixed spots, color perception, decreased vision, BILATERAL and PAINLESS
  2. translucent white/yellow discoloration of the lens. Fundoscopic exam cataracts appears dark and red reflex absent
35
Q

Cataracts

  1. tx
A

Important to prevent secondary glaucoma

Intracapsular and extracapsular extraction of cataract with lens replacement. Prognosis is great, post-op blled is less than 1%

36
Q

Glaucoma

  1. Define/explain process
  2. Risk factors
A
  1. Increased IOP with optic nerve damage. Impediment of flow of aqueous humor through the trabecular meshwork and canal of Schlemm will increase pressure in ant chamber.
  2. 40 yrs and above. Fam hx of glaucoma or DM, common in African Americans, 2.5 million US population
37
Q

Chronic glaucoma (aka open angle galucoma)

  1. Findings
  2. Ocular hypertension
  3. Tx
A
  1. Loss of peripheral vision “TUNNELING VISION” bilateral. Increased IOP. Increased cup:disc ratio.
  2. Elevated IOP without optic disc damage=ocular hypertension
  3. Refer to optho. Screen for hx of DM. Meds that decrease IOP by reducing aqueous humor production (i.e. beta-blockers) or meds that decrease IOP by increasing outflow (i.e Latanaprost)
38
Q

Diabetic retinopathy

  1. % of population affected
  2. PE findings, which is worse?
  3. Tx
A
  1. 40% diagnosed diabetics. Leading cause of blindness in American adults
  2. non-proliferative (venous dilation, hemorrhages, microaneurysm, exudates, retinal edema) >>> proliferative (neovascularization, vitreous hemorrhage)
  3. Glu control, BP, lipid, renal fxn

laser photocoag (doesn’t always work)

39
Q

Hypertensive retinopathy

  1. Risk factors
  2. PE findings
  3. What damage may be done?
A
  1. Significant in pts with rapid elevations of BP (malignant HTN-caused by organ damage or pre-eclampsia in pregnant females)
  2. atherosclerosis, tortuous/narrow retinal arterioles, flame hemorrhages(rupture on retinal nerve fiber), “cotton wool spots” (white patches on retina), exudates
  3. Can result in vasocontrict, ischemia, pigmented lesions. Permanent, choroidal, optic nerve damage
40
Q

Macular degeneration

Risk factors

A

Older adults- leading cause of permanent visual loss.

Caucasion, F>M, family hx, smoking, +/- regular aspirin use. Toxic effect of meds (i.e. Chloroquine)

41
Q

Macular degeneration

  1. Findings
  2. Wet vs dry
A

Age-related maculopathy that is characterized by retinal drusen extracellular deposits (seen on image as yellow deposits)

  1. Large associated with wet: neovascular/exudative, high severity

vs.

dry: atrophic/geographic, less severe than wet.

Both have gradual progressive bilateral visual loss

42
Q

Macular degeneration

tx

A

None. Can attempt to stabilize/slow progression.

Diet: Vit C, E, zinc, copper… etc.

Intravitreol injection: VEGF inhibitors to stop production of new vessels

43
Q

Papilledema

  1. Risk factors
  2. sx/sxs
A

Optic disc swelling, secondary to elevated intracranial pressure

Risk factors: malignant hypertension, hemorrhagic stroke, acute subdural hematoma, meningitis, tumors, etc..

  1. HA, N/V, pulsatile tinnitus, diplopia, “blind spots”
44
Q

Papilledema

Findings: early, late, chronic

A

Early- disc hyperemia, subtle edema, small hemorrhages.

Late- obscuration of normal disk margins (elevated disk), venous congestion, paton line.

chronic- gray or pale disc, disc pseudodrusen

45
Q

Papilledema

Frisen scale (0-5)

A

0- normal disc

1- C shaped halo of disc edema

2- circumferential halo of edema on optic disc

3- elevation of the optic disc with partial obscuration of one of more segments of blood v. at disc margin

4- almost complete obscuration of major blood v. on optic disc

5- partial or total obscuration of all blood v on surface of optic disc

46
Q

Papilledema

  1. dx
  2. tx
A
  1. CT/MRI. MR venography. Optic coherence tomography. Fluorescein angiography. B-scan ultrasanography. Humphrey visual fields. Lumbar puncture- obtain opening pressure
  2. Treat underlying cause. HOB (head of bed) elevation greater than 30 degrees. Diuretics. Weight reduction. Pt requires close monitoring by ophtho.
47
Q

What does lesions anterior to the optic chiasm affect?

A

Only one eye

48
Q

What does lesions at optic chiasm affect?

A

Both eyes partially

49
Q

What does lesions posterior to optic chiasm affect?

A

Corresponding defects in both visual fields

50
Q

Nystagmus

  1. Define
  2. What are two types
A

rhythmic oscillation of the eyes

May be normal or indicate: central d/o or peripheral d/o

Types: Pendular- equal velocity both directions

jerk- slow phase of movement followed by a fast phase in oppositve direction (Gaze evoked or vestibular)

51
Q

Gaze-evoked Nystagmus

A

When the pt attempts to gaze in one or more directions away from the primary position

single direction: early/residual ocular palsy

multidirectional- sedatives, central/cerebellar vestibular)

52
Q

Vestibular Nystagmus

A

increase with gaze towards the fast phase and is accompanied by vertigo when caused by a lesion of peripheral vestibular apparatus.

unidirectional and horizontal associated with severe vertigo

53
Q

Central Vestibular Nystagmus

A

bidirectional and purely horizontal, vertical, or rotary and accompanied by mild vertigo

54
Q

Positional Nystagmus

A

elicited by changes in head position, can occur with peripheral (eval for hearing loss or tinnitus) or central lesions (eval for corticospinal tract or cranial nerve abnorms)

55
Q
A

RRCCPA ClinMed (3 decks)

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