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1
Q

how do you manage corneal ulcer

A

give topical antibiotic eye drops, swab, refer to ophto

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2
Q

how do you manage globe penetration

A

my need IV abx

URGENT refer to ophtho

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3
Q

best dilator to use in adults

A

tropicamide

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4
Q

best dilator to use in kids

A

cyclopentolate

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5
Q

most concerning drug for someone about to have cataract surgery?

A

flomax–floppy iris syndrome

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6
Q

what are the signs of parinaud’s

A

convergence/retraction nystagmus and upward gaze palsy

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7
Q

is cataracts reversible or irreversible vision loss

A

reversible because surgery

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8
Q

how do you distinguish between preseptal and orbital cellulitis

A

orbital causes pain and affects eye movements

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9
Q

how do you test for sarcoidosis?

A

ACE levels
serum Ca
CXR

then either serum protein electrophoresis or lacrimal gland bx

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10
Q

what do you do if an exotic dancer and contact lens user complains of spot on cornea that lights up with flouresciene

A

refer to ophtho

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11
Q

most common cause of loss of vision in HIV positive patient with low CD4 count

A

CMV retinitis

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12
Q

what eye pathology should you suspect in an asian lady

A

closed angle glaucoma

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13
Q

what is a concomitant strabismus

A

manifest eye deviation

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14
Q

if you have trauma to the orbit and patient presents with subcutaneous emphysema of eyelid, what should you suspect

A

ethmoid bone fracture

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15
Q

what is a common symptom of cataracts

A

difficulty driving at night

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16
Q

what medications should you worry about in a patient going for cataract surgery

A

TAMSULOSIN–floppy iris syndrome

is an alpha-1 antagonist

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17
Q

what drug is contraindicated in a patient with HTN and renal calculi

A

diamox

it is a carbonic anhydrase inhibitor which increases the risk of renal calculi and is also used to treat glaucoma

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18
Q 
which of the following is NOT a cause of leukocoria?
cataract
retinoblastoma
high refractive error
not aligning ophthalmoscope properly
A

high refractive error is NOT a cause of leukocoria

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19
Q

what muscles are involved when the patient looks down and to the left

A

left eye–IR

right eye–SO

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20
Q

in a patient who has had HTN for a long time, what would you expect to see on retina exam

A

copper/silver arterioles

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21
Q

in a patient with less long standing HTN, what might you expect to see on retina exam

A

flame hemorrhages and exudates

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22
Q

what effect does HTN have on the retina

A

get arteriolar sclerosis–> thickening of vessel wall–> increased width of central light reflex

this progresses to the light reflex occupying the width of the vessel–> copper wire arterioles

when the light reflex is totally obscured, you get silver wire arterioles

severe A/V nicking can lead to BRVO–> retinal hemorrhages and cotton wool spots

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23
Q

what effect can an acute rise in BP have on the retina

A

fibrinoid necrosis of the vessel wall–> exudates, cotton wool spots, and flame shaped hemorrhages

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24
Q

what is the difference between a tropia and a phoria

A

tropia–> manifest (always present)

phoria–> latent, only comes out during crossover test or when take away ability of eyes to communicate with each other

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25
Q

if a patient’s left eye is slightly misaligned, approximately to the same degree in all directions, what do they have?

A

concomitant strabismus

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26
Q

what is the treatment of strabismus

A

patching and glasses

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27
Q

what causes amblyopia in a kid

A

strabismus
refractive error
form deprivation (i.e cataracts, corneal scarring, ptosis)

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28
Q

should you treat amblyopia with pilocarpine?

A

NO

this is a cholinergic and will thus cause constriction not dilation

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29
Q

what is true about amblyopia

A

can be present in both eyes

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30
Q

can you still do patching in a kid with amblyopia who is 10 years old

A

yes tho may not work as well

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31
Q

will a patient need cataracts after surgery?

A

yes

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32
Q

define amblyopia and management

A

loss of VA in absence of detectable organic disease (strabismic or refractive)

manage by detecting early and referring to ophtho

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33
Q

define strabismus and management

A

misalignment of the eyes

refer to ophtho

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34
Q

define esotropia/esophoria

A

deviating inwards towards the nose (most common)

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35
Q

define exotropia

A

outward deviation

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36
Q

how do you detect a tropia

A

cover tests (does eye move when the cover is removed?…if moves in, exotropia/moves out, esotropia/moves up, hypotropia/moves down, hypertropia)

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37
Q

how do you detect a phoria

A

alternating cover test–> esophoria if uncovered eye moves out/exophoria is uncovered eye moves in

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38
Q

how do you perform a swinging light test

A

have patient look/focus on a distant object in a low light room

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39
Q

27 year old patient has left dilated pupil, right constricted pupil in bright light. what does she have

A

left adie tonic pupil–> dilated pupil that is slow to constrict and re-dilate and decreased reflexes

nothing we can do

is benign, idiopathic, found in young women, unilateral

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40
Q

what lens would you give to a patient who cant see at a distance and cant read up close

A

myopic and presbyopic

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41
Q

a patient presents post cataract surgery with some sort of opacification/haziness on ophthalmoscopy. what is the problem

A

posterior capsule opacification

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42
Q

how does NPDR (non proliferative diabetic retinopathy) present

A

first manifestation–> micro aneurysms

retinal findings–> dot and blot hemorrhages, hard exudates, cotton wool spots (infarct of the nerve fibre layer) and macular edema

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43
Q

how does PDR (proliferative diabetic retinopathy) present

A

retinal ischemia leads to neovascularization over the optic disc or elsewhere–> fragile vessels can bleed into the vitreous and can lead to traction retinal detachment

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44
Q

how do you treat NPDR

A

laser and anti-VEGF

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45
Q

how do you treat PDR

A

laser burns—can do panretinal photocoagulation (PRP laser) and anti VEGF

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46
Q

how do you manage a corneal ulcer as a family doc

A

patch eye and evaluate in the morning

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47
Q

what do you use to evaluate macular degeneration

A

amsler grid

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48
Q

how does acute angle closure glaucoma present

A 
red eye that is painful 
fixed mid dilated pupil 
tearing
nausea/vomiting
halos
headache
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49
Q

what medication should you NOT use in a patient with both glaucoma and asthma/COPD

A

beta adrenergic blockers (-“olol”)

these treat glaucoma by reducing formation of aqueous humour but can cause bronchospasm in asthmatics

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50
Q

how does pilocarpine work in treating glaucoma

A

cholinergic

increases aqueous humour flow through trabecular meshwork

can cause decreased vision and headaches

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51
Q

name an alpha 2 andrenoreceptor agonist and how does it work to treat glaucoma

A

brimonidine tartrate

decreases aqueous production and increases uveoscleral aqueous outflow (non trabecular meshwork)

can cause dry mouth, headache, fatigue

52
Q

what med should you not use in a patient with HTN and glaucoma

A

epinephrine (adrenergic stimulators)

causes cardiac arrhythmias and increased BP

53
Q

how do prostaglandin analogues treat glaucoma and what are the side effects

A

-“prost”

increases aqueous flow outflow though the uveoscleral path

can cause darkening of iris

54
Q

name the only oral glaucoma drugs

A

carbonic anhydrase inhibitors -“amide”

55
Q

what are side effects of carbonic anhydrase inhibitors used to treat glaucoma

A

-“amide”

paresthesias, anorexia, GI disturbance, headache, predisposes to renal calculi

dont use in HTN

56
Q

lady comes in with new onset floaters, whats the cause

A

either retinal detachment or PVD

57
Q

what condition is characterized by a cherry red spot

A

CRAO

spot forms due to ischemia to the rest of the retina but the macula is supplied by the choroidal artery (from the posterior ciliary artery) instead of the central retinal artery so when you get CRAO only the macula is well perfused causing it to appear as a cherry red spot

58
Q

what condition is suggested by flame hemorrhages

A

HTN retinopathy

59
Q

how does wet AMD differ from dry

A

in wet AMD, you get choroidal neovascularization

60
Q

where do people notice vision loss in AMD

A

changes tend to be confined to the posterior pole so losses in central vision often are more pronounced

61
Q

how do you manage hyphema

A

refer URGENTLY

62
Q

how do you manage an orbital puncture

A

hard shield

NO antibiotic

63
Q

if a woman has herpes simplex keratitis and had vesicles above her forehead, what could she also have

A

iritis

64
Q

what condition requires the most urgent treatment in the ER

A

lye splash in the eye

65
Q

how do you treat chemical burns

A

irrigate excessively and refer

66
Q

patient comes in with a deep lid laceration close to the canthus–what is most likely also damaged

A

lacrimal canaliculi

67
Q

patients has thyroid eye disease and massive proptosis. what symptoms would they NOT have

A

pain on eye movement

WILL have:
dry eyes
corneal abrasions likely
diplopia on side gaze

68
Q

what vision abnormality is caused by thyroid eye disease

A

horizontal diplopia

69
Q

if a young woman who is morbidly obese, what will you most likely find on ophthalmoscopy?

A

papilledema (pseudotumour cerebri predisposition)

70
Q

what abnormality is caused by an optic chiasm lesion? (i.e is a person has a pituitary tumour close to the optic chiasm)

A

bitemporal hemianopsia

71
Q

what symptoms are associated with amaurosis fugax

A

transient sudden monocular vision loss

72
Q

when is a person considered legally blind

A

20/200 after corrected vision

73
Q

what should you NOT give a person with macular degeneration

A

anti-metabolites

74
Q

patient comes in after blunt trauma to the eye–what do you do

A

get more history

75
Q

what do you do if you see RBCs in the anterior chamber on ophthalmoscopy

A

URGENT referral (hyphema)

76
Q

what should you use to dilate a patients eye

A

tropicamide 0.5%… lasts only 6 h

77
Q

what should you do if a patient comes in with allergies?

A

oral antihistamine (not topical)

78
Q

what do you do for penetrating globe injuries?

A

shield and refer

do NOT manipulate the eye

79
Q

lady in an accident, loses glasses, face mashed up. vision in ER is 20/200. ifn o eye damage, what improvement can you expect on pinhole

A

unsure–20/30?

80
Q

risk factors for open angle glaucoma

A

age

african american heritage

81
Q

patient working with nail gun…now foreign body sensation. see corneal abrasion with fluorescein. what do you do

A

URGEN X RAY of skull bones

82
Q

girl with orbital fracture blows nose and feels crepitus. what did she also break

A

ethmoid

83
Q

how do you diagnose glaucoma in the office

A

ophthalmoscopy (cup:disc ratio)

…or vision field testing

84
Q

what test does not test for sarcoid

A

protein electrophoresis

85
Q

neighbour in cariboo doing lawn work, gets stuff in his eye, on inspection there is no corneal abrasion, normal red reflex, everything normal. what do you do

A

urgent/same day ophtho referral

86
Q

you are on call hospitalist… 92 year old lady has red eye but swats everyone away when they come near. what do you do

A

evaluate her yourself as could be acute angle closure glaucoma

87
Q

person comes to office with some conjunctival injection and discharge–otherwise normal. no corneal damage. what do you prescribe

A

topical abx–broad spectrum for bacterial conjunctivitis

88
Q

what is a change you do NOT expect with aging

A

increased contrast sensitivity

89
Q

patient has gradual change in vision loss starting to affect function, especially driving at night. whats the problem

A

cataracts

90
Q

management of corneal ulcer

A

patch

91
Q

management of globe perf

A

shield, no drops

92
Q

what does a white eye reflex suggest

A

absence of red reflex is a cataract or retinoblastoma

93
Q

what is optic neuritis

A

inflammation and demyelination of optic nerve

causes acute vision loss with peri-ocular pain exacerbated by eye movement

RAPD if fellow optic nerve healthy

associated with MS

recover vision within weeks to months

use IV corticosteroid not oral

94
Q

what condition is optic neuritis associated with

A

MS

95
Q

what is the treatment for optic neuritis

A

IV corticosteroid (not oral

96
Q

what is ION

A

acute vision loss from microvascular infarction of optic nerve

sudden, PAINLESS, UNILATERAL loss of vision

anterior portion of nerve most vulnerable (AION) –> arteritic AION is associated with GCA and non arteritic AION which is also associated with disc ededma, unilateral vision loss upon waking either upper or lower vision

97
Q

what condition is characterized by unilateral vision loss on waking that is either the upper or lower area

A

non arteritic ION

98
Q

management of CRAO

A

urgent referral

EMERGENCY

99
Q

presentation of BRAO

A

partial vision loss

100
Q

presentation of CRVO

A

blood and thunder

NOT an emergency

101
Q

how does optic neuritis present

A

sudden decrease in VA

clear ocular media

swollen disc

RAPD (disc swollen and hyperemic)

102
Q

management of optic neuritis

A

refer non urgently and give IV steroids

103
Q

what are the signs of GCA (giant cell arteritis)

A 
over 60
temporal headaches
jaw claudication
neck discomfort
sudden vision loss
RAPD
swollen disc
loss of vision
104
Q

define RAPD

A

relative afferent pupillary defect

105
Q

management of GCA

A

order ESR/CRP

if elevated, give high dose systemic steroids and IMMEDIATE ophtho referral

106
Q

what conditions should you refer URGENTLY

A

retinal detachment
acute CRAO
ischemic optic neuropathy if suspected to be related to GCA

107
Q

signs of retinal detachment and management

A

floaters
flashing lights
peripheral visual field loss

URGENT referral

108
Q

what is the first thing you can detect in glaucoma?

A

peripheral visual field loss–> scotomas

hard to detect early on

109
Q

symptoms of chronic angle closure glaucoma

A

intermittent

low grade sx–headaches, blurred vision

110
Q

when to refer someone with AMD to ophtho

A

recent decrease in VA
recent metamorphosia
recent scotoma
ophthalmoscopic findings of drusen, degenerative changes in RPE, choroidal neovascularization, poor central vision

111
Q

what are drusen

A

yellow hyaline nodules

can be associated with AMD

112
Q

danger symptoms of the red eye

A

blurred vision
severe pain
photophobia
colored halos

REFER

113
Q

danger signs of red eye

A 
reduced VA
ciliary flush
corneal opacification 
corneal epithelial disruption 
pupillary abnormality 
shallow AC depth 
elevated IOP
proptosis

REFER

114
Q

what should you do for a traumatic optic neuropathy (i.e maxillofacial trauma)

A

refer

115
Q

how urgent are orbital factures

A

semi urgent

116
Q

does uveitis cause changes in vision

A

posterior uveitis does cause visual field loss and scotoma

117
Q

patient with bump on eyelid, painful. doc had given abx PO. no effect. what do you do?

A

apply warm compresses 4x daily
massage the lid
apply topical abx
refer for incision and curretage if no resolution in 4 weeks

118
Q

symptom of bilateral INO

A

nystagmus of both eyes

119
Q

how do you investigate Horners

A

carotid U/S

120
Q

management of temporal arteritis

A

IV corticosteroids and bx

121
Q

what are symptoms of a cranial nerve III palsy

A

complete paralysis of the oculomotor nerve

causes both horizontal and vertical diplopia, severe ptosis of the upper eyelid, inability to move eye inward, upward or downward

pupil may be dilated and unresponsive

122
Q

common causes of CN III palsy

A 
intracranial aneurysm
microvascular infarction within nerve
trauma
cerebral herniation
brain tumour
123
Q

management of CN III palsy

A

emergent imaging and angiography

124
Q

what muscle is affected when a person has a lac in their upper eyelid and cannot open eye

A

levator palpebrae superioris

125
Q

in a question about brainstem and the orbits, which statement is false

A

something about syphilis

126
Q

which conditions mimic functional blindness with all eye exams being normal

A

cortical blindness

127
Q

guy comes in with high BP, no previous eye problems, wakes up one morning with decreased vision in one eye

A

NAION

ophtho (5 decks)

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