TEST PREP Flashcards
Which nerves control the muscles of the eyes?
III, IV, VI
What are the 3 layers of the eye?
Sclera, Cornea (continuous) - Outer layer
Choroid, ciliary body, iris - Middle layer
Retina - Inner layer
What are the 3 chambers of the eye?
Anterior - aqueous humor
Posterior - between iris and lens - aqueous humor
Vitreous - lens to back of retina
What is the white of the eye?
Sclera
What makes the eyelid have a rigid structure?
The Tarsal plate
Dacrocysitis - S/S
infection of lacrimal sac.
Pain, swelling, tenderness, possibly pus, redness
People at risk for dacrocystitis
Infants
Over the age of 40
Dacrocystitis treatment
systemic antibiotics, elective surgery, relief of obstruction
Glaucoma - acute closed angle S/S
Pain! Blurred vision, Halos
Dilated pupil, not reactive to light
Hard eye on palpation (increased IOP)
Glaucoma - chronic open angle S/S
asymptomatic.
Found in routine exam
Glaucoma - acute closed angle Tx
Reduce IOP
Pilocarpine
Surgery/Laser iridotomy/ectomy
Glaucoma - chronic open angle Tx
Prostaglandin analogues
B blockers
A2 agonists
Glaucoma differential
Conjunctivitis, acute uveitis, corneal disorders
What is the leading cause of blindness worldwide?
Cataracts
Cataract S/S
progressive blurring, glare, nearsightedness, double vision (monocular). Diminished red reflex
Cataract treatment
Surgery/laser
Cataract risk factors
Age over 60, smokers
Conjunctivitis etiology
bacteria, viral, allergic (seasonal)
Bacterial Conjunctivitis S/S
Direct contact, mucopurulent discharge.
Viral Conjunctivitis S/S
Watery discharge, unilateral to bilateral, periauricular adenopathy,
Allergic Conjunctivitis S/S
pruritic, bilateral, seasonal
Bacterial Conjunctivitis Tx
Antibiotic drops (sulfonamides)
Viral Conjunctivitis Tx
cold compress, artificial tears, vasoconstrictor drops
Allergic Conjunctivitis Tx
Antihistamines
What are two great places to contract conjunctivitis?
Swimming pools, eye doctor
What nerve does herpes simplex keratitis involve?
Trigeminal nerve
Herpes simplex keratitis S/S
dendritic/geographic ulcers of corneal area, red eye, pain, photophobia, tearing, reduced vision
Herpes simplex keratitis Tx
debridement, patching, topical antiviral, severe - corticosteroids
Risk of Retinopathy of Prematurity
Low birth weight, Low gestational age.
Xanthelasma. What is it?
Lipid deposits bilaterally around the orbits of the eye. Associated with hypercholesterolemia.
Xanthelasma Tx
removal
Who gets Arcus Senilis?
Old people. Normal.
Young people. Hyperlipoproteinaemia.
Arcus Senilis S/S
Deposit of lipids in a ring around the cornea.
Does Arcus Senilis affect vision?
no
Episcleritis S/S
Involvement of the sub layer of the conjunctiva. Red eye. inflammation, pain.
Scleritis S/S
Inflammation of Sclera, pain, redness
Episcleritis Tx
Self limiting, topical antiinflammatory
Scleritis Tx
High dose systemic steroids
Uveitis causes
Immunologic, infection. Results in intraocular inflammation.
Uveitis S/S
HYPOPYON, unilateral pain, redness, photophobia, visual loss,
Uveitis differential
retinal detachment, intraocular tumor, cns lymphoma
Uveitis Tx
Anterior: topical corticosteroids
Posterior: Systemic, periocular, intravitreal corticosteroids
Papilledema causes
Swelling of the optic nerve due to IOP.
Papilledema S/s
Episodes of vision loss, headache, N/V, bilateral.
Papilledema Tx
Weight loss, acetazolamide,
Papilledema Risk
People over weight
Dry eye syndrome causes
Hypofunction of lacrimal glands
Dry eye syndrome S/S
Dryness, redness, foreign body sensation, photophobia, difficulty moving eyelids
Dry eye syndrome Tx
Artificial tears
Dry eye syndrome risks
Old ladies
What is myopia?
difficulty seeing far away (near sighted)
What is hyperopia?
difficulty seeing close (farsighted)
What is presbyopia?
Age related vision loss, lens looses contractility, difficulty seeing near objects.
What is astigmatism?
Corneal refractive errors in the horizontal and vertical axes.
What is the cause of subconjunctival hemorrhage?
Trauma
Subconjunctival Hemorrhage S/S
blood in eye, minimal discomfort, deep red accumulation of blood under conjunctiva
Subconjunctival Hemorrhage Tx
cold compress, artificial tears for 1-2 weeks
What is hyphema?
Blood in the anterior chamber of the eye. Pain, blurry vision, red eye.
What is the treatment of hyphema?
immediate referal
Anterior Blepharitis involvement
inflammation of skin, eyelashes, glands… ulcerative, seborrheic.
Posterior Blepharitis involvement
Meibomian gland, staph infection, gland dysfunction (acne rosacea)
Anterior Blepharitis S/S
irritation, itching, burning, red rimmed, scales/granulations on lashes
Posterior Blepharitis S/S
lids are hyperemic/telangiectasia, inflamed and dilated glands, abnormal secretions, mild entropion, frothy/greasy tears.
Blepharitis Tx
Ant - clean the lid, brows, scalp. Anti staph ointment
Post - Meibomian gland expression.
What is Horner’s syndrome?
Loss of sympathetic function to an eye, due to disease (tumor… neck, chest).
What are the S/S of Horner’s?
Constricted pupil on one side (unable to dilate)
Strabismus S/S
deviation of one eye. deviation of visual axis
Strabismus causes
Accommodation for refractive error, idiopathic, retinoblastoma, optic nerve conditions.
Strabismus Tx
Treat underlying condition
Amblyopia S/S
visual disturbances with no gross pathology
Amblyopia causes
Lazy eye. Strabismus, physical occlusion, refractive errors
Amblyopia Tx
treat underlying condition
Retinal Detachment cause
Fluid separates retina from underlying layer
Retinal Detachment S/S
Flashes, Floater, decreased visual acuity, PVD, vitreous hemorrhage
Retinal Detachment Tx
Refer it, fool! surgery
What is the leading cause of blindness in the US?
Diabetic Retinopathy
Diabetic Retinopathy S/S
micro aneurisms, retinal hemorrhage, hard exudates, macular ischemia, neovascularization, macular edema.
Diabetic Retinopathy Tx
intravitreal injections, grid lasers
Diabetic Retinopathy Risks
DM, HTN, smoking, Hyperlipidemia
When should a Type 1 diabetic get an eye exam?
3-5 years after initial diagnosis. Yearly after that.
When should a Type 2 diabetic get an eye exam?
At diagnosis. Yearly after that.
Ischemic Optic Neuropathy cause
Anterior optic nerve become ischemic due to degenerative disease of arterioles.
Ischemic Optic Neuropathy S/S
Sudden loss of vision (often upon waking),
Giant cell arteritis - pain or scalp tenderness
What is the most common cause of legal blindness?
Macular degeneration
What is the cause of macular degeneration?
unknown
What are the signs and symptoms of Dry macular degeneration?
Atrophy of the renal pigment epithelium.
What are the S/S of Wet macular degeneration?
Exudative, blood blister-like in the eye. Blurred vision, metamorphopsia.
What is the Tx of macular degeneration?
Intravitreal injections!!!!
Cold laser, surgery
Who are at most risk for developing macular degeneration?
Old, White, Female, Smokers, Genetics
What is the cause of corneal abrasions?
trauma
What are the S/S of corneal abrasions?
Pain, watery, red eye, epithelia defect (seen on fluouridian stain)
Corneal abrasion Tx
Artificial Tears, antibiotics, bandage if big!
Orbital Wall Fracture cause
trauma
Orbital wall fracture S/S
pain with eye movement, Double vision, Eyelid swelling, Facial numbness, Enophthalmos
Orbital wall fracture Tx
surgery, refer
Orbital cellulitis cause
bacterial infection of periocular tissue
Orbital cellulitis S/S
Unilateral, pain, fever, swelling of lids and periorbital tissue, tenderness.
Orbital cellulitis Tx
oral, IV antibiotics
Sino-orbital imaging to assess extent
Who’s at highest risk for orbital cellulitis?
Children
What is endophlamitis?
Intraocular infection, possibly following surgery.
What are the S/S of endophlamitis?
pain, conjunctiva inflammation, reduced vision, hypopyon.
Endophlamitis Tx
Refer! vision threatening
Retinitis pigmentosa cause
Progressive visual loss from photoreceptor death. Starts with rods and eventually involves cones.
Retinitis pigmentosa S/S
night blindness, photophobia, peripheral field loss, bilateral pigment clumping, waxy palor of optic nerve.
Retinitis pigmentosa Tx
No fix
Who is at risk of Retinitis pigmentosa?
Runs in the family
What causes optic neuritis?
Demyelinization of the optic nerve.
What are the S/S of Optic Neuritis?
Unilateral vision loss, Pain with eye movement, Transient neurological disturbance (N/V), visual field deficit.
Optic Neuritis Tx
Sulomedrol, prednisone, GI prophylaxis
Who is at risk for developing Optic Neuritis?
People with MS, ages 15-45
Retinoblastoma cause
Tumor
Retinoblastoma S/S
White pupil, exo/esotropia, proptosis, inflammation.
Retinoblastoma Tx
Enucliation (eye removal), chemo, cryo
Who is at risk for retinoblastoma?
Children. Most common primary ocular malignancy.
What is a hordeolum?
Stye. inflammation of accessory glands or lash follicles.
What is a chalazion?
inflammation of the meibomian gland. deeper.
What is a pinguecula?
Hyperplasia of the epithelial layer of the conjunctiva. Does NOT cross the cornea.
What is a pterigium?
Hyperplasia of the fibrovascular layer of the conjunctiva. DOES cross the cornea.
Entropion
Inward turning of the eyelid. Lashes scratch the eye ball
Ectropion
Outward turning of the eyelid.
Exotropia
Lateral deviation of eye (strabismus)
Esotropia
Medial deviation of eye (strabismus)
Hypertropia
Upward deviation of eye (strabismus)
Preseptal cellulitis
Cellulitis of the anterior, outer eyelid
Postseptal cellulitis
Cellulitis of the contents of the orbit
Age Related Macular Degeneration vision loss
blurry vision, grid/straight line distortions, spot of partially diminished vision.
Cataract vision loss
progressive blurring of vision, glare, nearsightedness, double vision (monocular)
Glaucoma vision loss
blurred vision, halos
Aniscoria
difference in pupil size > 1 mm
Idiopathic, CNIII palsy, Horner’s Syndrome, Argyll Robertson pupil (accommodate but do not react)
Relative Afferent Pupil Defect
Swinging light effect. One pupil doesn’t constrict as much as the other.
What to refer?
Corneal ulcer, Retinal detachment, Iritis, Glaucoma, Retinal artery occlusion, Chemical burn, Hyphema, Hypopyon, Endophthalmitis, Herpes Simplex Keratitis, Herpes Zoster Ophthalmicus.
Cataracts Risk factors
Age over 60, SMOKERS, diabetics, chronic corticosteroid use
Macular Degeneration risk factors
Old, white, female, smokers, genetics
Open-angle Glaucoma
Over 40, Black, hispanic
Angle closure glaucoma
Old age, asians, farsightedness, inherited
Siedel’s sign
Fluouroscopy shows a puncture of the eye and fluid flowing out.
What’s worse in the eye, acid or base?
Base!
