1
Q
Blepharitis
A
- chronic lid inflammation
- Staph/Strept, seborrhea, meibomian gland dysfxn
- scurf (flake) & collarettes (fibrous), clear conjunctiva, thick/cloudy d/c if meibomian eti, lids can adhere
- gentle shampoo, warm compress, massage, abx if inf
2
Q
Blowout fx
A
- MC orbital fx
- anesthesia of infraorbital area, diplopia
- assess VA, EOM (dec upward gaze), XR (teardrop sign: fat into max sinus - open bomb-bay door sign: bone frags in sinus)
- CT if abnml XR
- ophtho ref, surg repair if persistent diplopia or en/exophthalmos, abx ppx if sinus involved
3
Q
Cataracts
A
- opacification of lens
- gradual loss of vision +/- double vis, blurry, glares, dec vision in bright/night; typically bilateral
- Age, steroid/statins, DM, trauma
- surgery (once mature, can’t see retina on fundoscopy)
4
Q
Chalazion
A
- chronic inflam, painless, deep from palpebral margin
- warm compress, ophtho ref for surg/steroid inj if refract
5
Q
Hordeolum
A
- acute onset, edema, pain, deep from palpebral margin
- S. aureus, not contagious
- internal (meibomian) or external (glands of Moll/Zeis adj to edge of palpebral margin)
- warm compress x 48 hrs then I&D if no improvement, abx if 2ndary infection
6
Q
Viral conjunctivitis
A
- acute, unilateral, watery d/c, highly contagious (adenovirus = MC), midsummer-early fall, tender preauricular LAD
- lavage, vasoconstrictor/antihist for sx relief, warm/cool compress
7
Q
Bacterial conjunctivitis
A
- common: strept pneumoniae, s. aureus, haemophilus aegyptius, moraxella
- rare: gonorrheae (copious d/c, unilateral) and chlamydia (mucopurulent d/c, nontender preauricular LAD) - both via sex, vag delivery, risk of permanent visual impairment, may need sys abx
- d/c throughout day, cx if sev
- abx (erythro oint, sulfacetamide drops, FQ drops if contacts (pseudomonas): drops > oint
- if no resp in 2 days, or need steroids, ophtho ref
8
Q
Hyphema
A
- blood in anterior chamber s/p trauma
- vision loss, pain, N/V, photophobia, elevated IOP
- emergent ophtho ref if blood dyscrasia, sickle, open globe
- orbital CT to r/o open globe
- severity grade 1-4 (< 33% - 100% filled)
- eye shield/reading restrict x 1wk/til resolved, elevate head (ppx blood settling), sx control +/- steroids, surg if > 10 days/diff control IOP
9
Q
Dacryoadenitis
A
- inflam/inf of lacrimal gland
- autoimmune or thyroid dz, orbital pseudotumor
- pain, tearing, d/c, preauricular LAD
- warm compress, massage, ophtho ref if no improvement
10
Q
Dacryocystitis
A
- inf w/in lacrimal drain sys bc of obstruction
- EBV, mumps, staph, gonorrhea, candida
- upper lid swelling, red, warm
- emergent ophtho ref + clinda/vanc for MRSA, think CA if refractory
11
Q
Dacryostenosis
A
- common after 1 month old, duct not open, resolved by 9 mos
12
Q
Entropion
A
- eyelid folds in
- genetic, congenital, inf (chlamydia), aging, scarring
- wind sensitive, dec VA, red/pain, photophobia
- surg repair to ppx permanent corneal damage
13
Q
Ectropion
A
- aging/tissue weak, allergic, facial nerve palsy, chemo tx, congenital
- sagging lid, dull light reflex, irritation
- surgical repair
14
Q
Corneal abrasion
A
- trauma, FB, contact lens
- severe pain, FB sensation, photophobia, tearing, blurred vision, HA, blepharospasm, conjunctival injection
- r/o FB, HSV keratitis w/ fluorescein stain w/ UV light
- irrigate, pain control, pressure patch (NOT > 24 hrs), NO steroids
- ophtho ref if corneal infiltrate/opacity
- most heal w/in 24-72 hrs
15
Q
Corneal ulcer
A
- inf/inflam corneal abrasion
- dendritic lesion = herpes keratitis
- concerned in contact wearers
- ophtho ref, stain/cx
- no topical steroids (inc risk of perforation/tissue loss
16
Q
FB
A
- surface vs intraocular (blurred vision, discomfort)
- VA test, look for FB, fluorescein stain, CT/XR
- ophtho ref for intraocular, remove, metal w/ rust ring resorb (do NOT remove), erythro oint & patch s/p removal
- fu w/ ophtho in 48 hrs
- if chem burn: irrigate x 30 min then ED/ophtho
17
Q
macular degeneration
A
- damage to retina = IRREVERSIBLE, gradual, central vision loss
- non-exudative (dry): drusen bodies (loss of cones = 90% of cases)
- exudative (wet): blood vessels grow from choroid behind retina
- RF: age, genetics, smoking, HTN, meds (chloroquine)
- mgmt: zinc, copper, carotene vit supp, laser/surg extractions, antiangiogenesis tx (bevacizumab): most tx not very effective
18
Q
pinguecula
A
- RF: chronic actinic (sun) exp, rpt’d trauma, dry/wind
- elevated, fleshy conjunctival mass on sclera adj to cornia, nasal side (can become inflam’d)
- surg resect if irritated
19
Q
pterygium
A
- slow growing/thickening of bulbar conjunctiva, uni/bilat
- highly vascular, triangular mass from nasal toward cornea, CAN interfere w/ vision
- RF: UV exp, abnml angiogenesis, HPV
- excision recurrence is common, can be more aggressive
20
Q
nystagmus
A
- reg/rhythmic oscillation of eye
- vertigo, oscillopsia, abnml head position, blurred vision
- jerk nystagmus: imbalance in semicircular canals from periph vestibular dz
- pendular nystagmus: slow/sinusoidal oscillations, acquired/congenital
- ddx: Li/antisz, EtOH, brainstem stroke, thiamine/Mg def, chiari, encephalitis, demyelinating dz
- tx cz/if sx, baclofen for periodic alternating, gabapentin for pendular, botox inj, prism contact lens/glasses, surg correction of EOM
21
Q
glaucoma ppx eye exam sched
A
Black:
- 20-40: q 2-4 yrs
- 40-54: q 1-3 yrs
- 55+: q 1-2 yrs
White:
- 40-54: q 2-4 yrs
- 55-64: q 1-3 yrs
- 65+: q 1-2 yrs
22
Q
Closed/Narrow/Acute Angle Glaucoma
A
- malformed iris & trabecular network = fluid build up BEHIND lens (inc IOP + optic nerve damage)
- asians/elderly
- sx MC s/p dark exp or anticholinergic use, pain, halos around lights, h/o recent eye surg/uveitis, prev blurred vision episodes, N/V, nonreactive pupil, hazy cornea, inc optic cup:disc
- acetazolamide + timolol, apraclonidine, pilocarpine
- emergent ophtho ref, monitor IOP
23
Q
Open/Wide Angle Glaucoma
A
- MC glaucoma, black 40+ or others 65+: screen w/ visual field confrontation (inc IOP + optic nerve damage)
- fluid build up IN FRONT of lens from clogged drains (canal of Schlemm)
- bilateral, colored halos around lights, progressive peripheral vision loss, asx til severe loss, pupil dilation, inc optic cup:disc
- reg exercise to reduce IOP, inc outflow w/ intraocular prostaglandin analogs (latanoprost), suppress prod w/ intraocular BB (timolol)
24
Q
Optic neuritis
A
- acute inflam demyelinating inj to optic nerve
- painful, monocular visual loss x several hrs/days, +/- papillitis on fundoscopy
- chronic: afferent pupillary defect, color desaturation, optic atrophy
- ddx: ischemia, inf (meningitis, syphilis, lyme), inflam (sarcoid, CA, SLE), compression (pseudotumor cerebri), tox/met (drugs, nutritional def, radiation), trauma
- MR brain/orbits w/ contrast
- IV methylprednisone if sev vision loss of 2+ white matter lesions on MR (PO = no benefit), interferon if MR suggest MS (may delay)
- prog: visual recovery in few wks, 30% develop MS w/in 5 yrs
25
Orbital cellulitis
- MC in peds s/p untx'd sinusistis/trauma
- Strep pneumo, H. flu, S. aureus
- proptosis (exopthalmos)/chemosis (conj swell), edema, hyperemia, pain, limited EOM, reduced vision
- CT/MR
- Admit for IV abx (amox, naficillin, metro/clinda, or ceftriaxone + vanc for severe)
26
papilledema
- optic disc swell from ICP (malignant HTN, hemorrhagic stroke, subdural hematoma)
- bilat, HA, N/V, diplopia, pulsatile machine-like sound in ear, intermittent/brief visual sx
- ddx: mass, cerebral edema, inc CSF prod/dec absorption, obstructive hydrocephalus, pseudotumor cerebri
- fundoscopy (disc swollen, blurred margins), VA, brain MR, LP
27
Retinal detachment
- RF: myopia (near-sighted), trauma, FHx, cataract surg, DM retinopathy
- sudden, painless, vision loss ("curtain"), flashes/floaters, defect in confrontational visual fields
- emergent ophtho consult & surg repair
- complete vision loss w/o surg, 80% recover w/o recur
28
DM Retinopathy
- leading cz of blindness in US
- T1 & T2, not gestational
- dilated ophth exam q yr
- nonproliferative: venous dilation, microaneurysms, retinal hemorhages/edema, hard exudates (lipid), soft exudates (cotton wool spots)
- proliferative: neovac, vitreous hemorrhage
- tx: glucose control, reg BP, laser photocoag, vitrectomy
- sev dz = permanent
29
Central retinal artery occlusion
- MC from embolus, can be thrombus/vasculitis
- RF: Afib, endocarditis, coagulopathies, CAD, hypercoag states, temporal arteritis (F, HA, scalp pain, jaw claud)
- painless/sev vision loss, unilateral
- fundoscopy: cherry red spot (perifoveal atrophy), splinter hems, ground-glass retina, pallor, edema, box-carring (separation of arterial flow)
- CV exam for bruits/temp arteritis, carotid US, EKG (dx/tx atherosclerotic dz to prev recurrence)
- emergent ophtho ref, lower IOP, antiplts, poor prog (no tx improves vision)
30
Central retinal vein occlusion
- RF: HTN, DM, HLD, mech compression, glaucoma, inflam of optic nerve, orbital dz, hyperviscosity d/o
- painless, unilateral vision loss, "blood and thunder" retina (dilated veins, hemorrhages, edema, exudates)
- tx underlying d/o, ASA, laser ischemic retina, tx assoc glaucoma/macular edema
- better prog (tx neovasc w/ VEGF inhibs: bevacizumab)
31
Strabismus (Tropia)
- lack of binocular fixation: esotropia (inward), exotropia (outward)
- can be uni/bilateral, nml until 4 mos old (ophtho ref)
- congenital: nerve palsy, prenatal drug exp, pseudostrab
- acq'd: GBS, botulsim, myasthenia gravis, MS, thyrotoxicosis, DM, inf
- cover/uncover test, corneal light reflex (misalignment)
- tx: exercises/patch, surgery if severe
- can develop amblyopia/diplopia if untx'd after 2 y.o.
- psudostrabismus: eyes appear misaligned, but light reflex nml/symmetric
32
Uveitis (Iritis)
- inflam & leukocyte infiltration of iris, ciliary body, and/or choroid and vitreous humor
- infectious: CMV, syphilis, HSV, cat scratch dz, toxoplasma
- immune: spondyloarthropathies, IBD, sarcoidosis, MS
- s/s: anterior chamber (pain, red) vs posterior chamber (painless floaters, vision loss)
- wu: slit lamp, fundoscopy
- tx: ophtho consult, tx inf, +/- steroids
33
Globe rupture
- do NOT palpate, apply pressure, use drops, or remove object
- VA via Snellen chart, IOP via Schiotz tonometer
- hospital for eval/tx
34
Amaurosis fugax
- painless temporary loss of vision in one or both eyes from occlusion or stenosis of the internal carotid artery (clot, vasospasm, plasma viscosity: MM, leukemia)
- RF: 50+ y.o, HTN, HLD, smoking, h/o TIA
- tx: lower BP, ASA/coumadin, surg (carotid endarterectomy), ppx stroke (high risk)
35
Scleritis
- uni/bilateral, +/- visual impairment
- inf, inflam, s/p surg (pterygium)
- 50% autoimmune
36
HTN Retinopathy
- greater risk if acute/accelerated HTN
- arteriolar narrowing, copper/silver wiring, AV nicking (atherosclerosis)
- control BP, sev dz = permanent
37
Burred vision/decreased VA lesions location/sx
- anterior to optic chiasm = one eye
- at optic chiasm = parial, bilateral
- posterior to optic chiasm = same side deficit
38
Transient vs sudden vs gradual vision loss dds
- transient: TIA, emboli (amaurosis fugax), temp arteritis
- sudden: vascular occlusion, optic neuropathy, papillitis, retrobulbar neuritis
- gradual: mac degen, tumors, cataracts, glaucoma
39
Blue/cyanotic sclera in infants = ___
osteogenesis imperfecta ("brittle bone dz")
40
Amblyopia
- reduced VA that is NOT correctable
| - MC by strabismus (can be uremia, toxins, EtOH, tobacco, lead)
PANCE HEENT (7%)
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