Eyes

Question 1

retinal detachment - definition, tx

Answer 1

usually spontaneous or traumatic

• flashers, floaters, “curtain” closing
• results in acute vision loss

tx: refer to ophthalmology

Question 2

retinal artery occlusion

Answer 2

acute, PAINLESS, loss of vision (unilateral)

• emergency!
• # 1 cause is carotid atherosclerosis (emboli occludes)

Question 3

retinal vein occlusion

Answer 3

subacute, unilateral blurriness

• “blood and thunder” fundus - leaking due to blockage and back-up of blood
• may resolve on own
• w/u for underlying cause
• risks: elderly, HTN, glaucoma, DM

Question 4

optic neuritis - definition, causes, sxs, tx

Answer 4

sudden inflammation of nervous tissue of eye; can destroy myelin

• unilateral vision loss
• loss of pupillary rx to light
• pain with EOEM

causes: infection, autoimmune dz (SLE, sarcoid), multiple sclerosis

tx:

• treat underlying cause
• may resolve on own
• corticosteroids, IV
• prognosis good unless MS or SLE

Question 5

causes of acute vision loss

Answer 5

retinal detachment
retinal artery occlusion
optic neuritis

Question 6

causes of chronic vision loss

Answer 6

glaucoma
cataract
macular degeneration
retinopathy

Question 7

glaucoma - definition, risks

Answer 7

increased intraocular pressure (IOP) and optic nerve damage

• visual field loss leading to blindness
• PREVENTABLE

risks: DM, HTN, hypothyroid, FH, African American

Question 8

glaucoma - two types

Answer 8

open angle: asymptomatic rise in IOP

• central vision spared
• most common / less severe

angle closure:

• ocular emergency!
• sudden, complete occlusion of aqueous humor flow
• pain, blurred vision, photophobia
• hazy cornea w/ fixed pupil
• N/V, sweating

Question 9

glaucoma - screening (3 things to check)

Answer 9

1. anterior chamber angle (bowing of iris)
2. optic nerve exam
   - cup: disc ratio (>0.5 = abnormal)
3. IOP>21 mmHg

Question 10

angle closure glaucoma - tx

Answer 10

TRUE ocular emergency

• immediate referral
• decrease IOP: carbonic anhydrase inhibitor (IV), osmotic agent (mannitol), pilocarpine drops (contract ciliary muscles and facilitate flow)

Question 11

glaucoma - general tx

Answer 11

promote drainage:
- cholinergic agents (pilocarpine)

decrease production:
- beta blockers

both
- alpha agonists

Can get surgical tx if not responding to meds

Question 12

cataract - definition, sxs, tx

Answer 12

opacity of lens (brown to yellow discoloration)

• white in pupil; appears dark against red reflex w/ otoscope
• slow, progressive loss of vision
• VERY common

tx:
- early: magnifying glasses
- later: surgical removal

Question 13

macular degeneration (age-related) - definition, sxs

Answer 13

yellowish, hyaline nodules that deposit in Bruch’s membrane and limit nutritional and metabolic support of macula

• sxs: gradual blurry vision, wavy or distorted vision, central bid spot
• PE: dec. acuity, drusen mottling, macular scarring

Question 14

retinopathy - definition, 2 major causes in US, tx

Answer 14

ischemic injury to retinal vasculature

causes: diabetes and HTN
tx: treat underlying DM and HTN

Question 15

blepharitis - definition, sxs, tx

Answer 15

inflammation or infection of eyelid
- “dandruff of eyelid”

sxs: irritation, burning, FB sensation, tearing, photophobia
tx: topical ABX (erythromycin), warm compress

Question 16

dacryocystitis

Answer 16

inflammation of lacrimal gland +/- duct

sxs: pain, swelling, tearing, drainage
- unilateral

tx:

• warm or cool compress
• oral ABX if infectious
• abscess: I&D

Question 17

hordeolum (stye)

Answer 17

infection of sebaceous gland (staph aureus)

• mildly painful nodule or pustule on lid
• can be internal (under lid) or external (facing outside)
• red, tender, comes to point

tx:

• warm compress (2-3 days)
• topical ABX if needed

Question 18

chalazion

Answer 18

chronic granulomatous inflammation of meibomian gland

• may arise post-stye
• PAINLESS

tx: warm compress

Question 19

ectropion - definition, tx

Answer 19

lid turns outward
- usually age-related

tx: botox (temporary); surgery

Question 20

entropion - definition, tx

Answer 20

lid turns inward

• usually age-related
• cause cause foreign body sensation

tx: botox (temporary); surgery

Question 21

orbital cellulitis - cause, sxs, dx, tx

Answer 21

cause: URI, sinusitis, lid trauma (kids)
- systemic dz

sxs: pain, erythema, fever, dec. vision

PE: erythema of lid and surrounding skin; RESTRICTED motility

dx: inc. WBC, CT: infiltration of orbital fat

tx:
- ADMIT: broad spectrum ABX (IV than PO 2-3 weeks)
Preferred: amoxicillan-clavulanate (augmentin)
PEN allergy or hx of MRSA: doxycycline

Question 22

viral conjunctivitis (pink eye) - sxs and tx

Answer 22

sxs: redness, mild discomfort, watery d/c
- tender preauricular nodes
- rapidly bilateral

tx:
- self limiting, cold to warm compress
- artificial teams, antihistamine drops

Question 23

bacterial conjunctivitis - sxs and tx

Answer 23

sxs: redness, irritated, purulent d/c, adhesions
- often bilateral
- often contact lens wearers

tx: ABX drops
- fluoroquinolone, polymixin, sulfa

Question 24

chlamydial conjunctivitis - sxs and tx

Answer 24

sexually transmitted

sxs: unilateral, scant purulent d/c

tx:

• systemic tetracycline or erythromycin
• topical ABX ointment

Question 25

allergic conjunctivitis - sxs and tx

Answer 25

seasonal, people w/ atopic hx sxs: mild injection, edema, cobblestoning - stringy d/c, edema tx: - remove allergen - systemic antihistamines - topical antihistamine

Question 26

pterygium

Answer 26

triangular wedge-shaped fleshy growth in eye that fold over into cornea - interferes with vision - localized inflammatory process tx: surgical excision, artificial tears, topcial NSAIDS or steroids

Question 27

herpes simplex keratitis - sxs, dx, tx

Answer 27

sxs: - unilateral, recurrent - HSV-1 >> HSV-2 - irritation, light sensitivity, redness dx: dendritic lesion (fluorescein stain) tx: REFER!! - topical anti-viral - NO STEROID - will cause tissue loss, ocular perforation

Question 28

herpes zoster ophthamicus - definition, sxs, tx, prevention

Answer 28

latent varicella virus that stays dormant on trigeminal ganglion sxs: pain, H/A, photophobia, malaise, fever - often w/ vesicular, pustular rash in dermatomal dist. Hutchinson's sign: lesions on tip of nose = ocular involvment tx: REFER - oral or IV antivirals (protect site) prevent: vaccine (Zostavax)

Question 29

corneal ulcer - definition, sxs, tx

Answer 29

infection and inflammation of cornea - history of trauma, contact lens use sxs: pain, photophobia, tearing dx: dense corneal infiltrate seen with fluorescein stain tx: REFER - avoid contact lens use

Question 30

corneal abrasion - definition, sxs, tx

Answer 30

small cut due to mild trauma sxs: conjunctival injection, photophobia, tearing - foreign body sensation dx: epithelial defect (fluorescein stain) - R/O ulcer tx: ABX ointment - F/U daily until resolves - If does not resolve in 1 day, refer for ulcer

Question 31

foreign bodies

Answer 31

tearing, red, irritated, painful evert lids for exploration remove under topical anesthesia - irrigate, forceps or q-tip - apply ABX ointment after removal

Question 32

subconjunctival hemorrhage - sxs and tx

Answer 32

``` spontaneous bleedings (confined to sclera) - usually following valsalva ``` tx: - reassurance - 2-3 wks to clear

Question 33

orbital fracture ("blow out") - cause, sxs, tx

Answer 33

fracture of tiny bones of orbit due to trauma (fist, ball) - bones "blow out" into maxillary sinus sxs: restricted, painful vertical eye movement - double vision, edema tx: REFER - CT to assess extent of damage and tx (likely surgery)

Question 34

hyphema

Answer 34

blood in anterior chamber - typically caused by trauma (think shaken baby if infant) sxs: pain, blurry vision, red eye, sluggish pupil, watery appearance tx: REFER - admit and monitor closely

Question 35

chemical burns

Answer 35

irrigate, irrigate, irrigate

Question 36

papilledema

Answer 36

increased pressure in or around the brain causes the part of the optic nerve inside the eye to swell - see on opthomascopic exam Sxs: fleeting disturbances in vision, headache, vomiting

Question 37

what test to you do to confirm refractory error (e.g. near sighted / far sighted)

Answer 37

pinhole test: vision will improve if due to refractory error

Question 38

amblyopia

Answer 38

loss of visual acuity (NOT correctable by glasses) in otherwise healthy eye - "lazy eye" - normal eye that is prohibited from developing - MOST OFTEN due to untreated strabismus tx: - treat underlying problem (strabismus or refractive error) b/f age of 6

Question 39

strabismus

Answer 39

unequal alignment of eyes - misalignment of eye axis due to unequal straight of eye muscles - can interfere w/ proper formation of visual cortex - hypotropia: downward - hypertropia: upward - exotropia: outward - esotropia: inward tx: - patch good eye - surgery (severe cases)

Question 40

myopia

Answer 40

nearsightedness

Question 41

hyperopia

Answer 41

farsightedness