Ophthalmology

Question 0

Amblyopia? Causes? Diagnoses? Management?

Answer 0

Poor vision caused by abnormal visual stimulation

1. Eye misalignment (strabismus) – suppression of nonpreferred eye
2. Any condition that causes of blurred visual image (cataract, Anisometropia, vitreous hemorrhage
3. In preverbal children – bilateral red reflex test is best test
4. In older children – formal acuity
5. Correct refractory errors
6. Patching

Question 1

Red reflex finding:

1. Dark, dull, or white reflex
2. Dark or dull reflex
3. Yellow or white reflex
4. Unequal red reflex
5. Bright or red reflex in deviated eye
6. Dull reflect

Answer 1

1. Cataract
2. Vitreous hemorrhage
3. Retinoblastoma
4. Anisometropia (Significant differences in refractive errors between eyes)
5. Strabismus (Lazy eye)
6. Glaucoma

Question 2

Chemical conjunctivitis?

Answer 2

Chemical irritation to eyes due to traps/appointment as prophylactic against Neisseria (especially 1% silver nitrate)

Question 3

Causes and timescale of conjunctivitis newborns? Tx?

Answer 3

1. Within 24 hours – chemical (watery discharge) – no treatment
2. 2-4 days of life – Neisseria (purulent discharge, swelling, Corneal ulcer) – topical erythromycin, IV cefotaxime
3. 4-10 days – Chlamydia (discharge, lid swelling) – Oral erythromycin
4. 6 days to 2 weeks – HSV (unilateral service discharge) – acyclovir, topical trifluorothymidine

Question 4

Causes of red, teary eyes in newborns other than conjunctivitis?

Answer 4

1. Congenital glaucoma
2. Dacyrocystitis (infection of nasolacrimal sac)
3. Endopthalmitis – can result in blindness

Question 5

Unilateral conjunctivitis associated with?

Answer 5

Foreign body, corneal ulcer, herpes simplex keratitis

Question 6

Clinical features of conjunctivitis (Discharge, itching, preauricular lymphadenopathy, labs)

1. Bacterial
2. Viral
3. Allergic
4. Blepharitis

Answer 6

1. Purulent, non-pruritic, no lymphadenopathy, Gram stain
2. Watery, pruritic, lymphadenopathy, none
3. Watery/mucoid, pruritic, no lymphadenopathy, eosinophils
4. None, none, none, staph aureus on culture

Question 7

Blepharitis – Causal organism? Clinical features? Management?

Answer 7

staff aureus

1. Burning, crusting, scales
2. Hyperemic eyelid margins
3. Broken/absent eyelashes
4. History of awakening in the morning with eyelashes stuck together

Eyelid hygiene, topical erythromycin

Question 8

Causal organisms of

1. Bacterial conjunctivitis
2. Viral conjunctivitis

Answer 8

1. H. influenzae, strep pneumo, Moraxella, staph aureus

2. Adenovirus

Question 9

Epidemic keratoconjunctivitis – Cause? Features? Management?

Answer 9

Andenovirus

1. Petechial conjunctival hemorrhage
2. preauricular lymphadenopathy
3. pseudomembrane on conjunctiva
4. Photophobia

Supportive

Question 10

Primary ocular HSV – Clinical features?

Answer 10

1. Skin eruption with multiple vesicular lesions

2. Cornual ulcer (rarely)

Question 11

Causes of hemorrhagic conjunctivitis?

Answer 11

H influenza, adenovirus, picornavirus

Question 12

Causes of abnormal tearing?

Answer 12

1. Nasolacrimal duct obstruction

2. Aminotocele

Question 13

Cause of nasolacrimal duct obstruction? Management?

Answer 13

Failure of complete canalization of lacrimal system

1. Observation (half resolved within six months)
2. Nasolacrimal massage/topical antibiotics
3. Nasolacrimal duct probing

Question 14

Amniotocele – Definition? Cause? Clinical features? Management?

Answer 14

Swelling of nasolacrimal sac; nasolacrimal duct obstruction

1. Bluish swelling in medial canthal area
2. Infection
3. Local massage
4. As about it and nasolacrimal duct probing

Question 15

Causes of ocular trauma?

Answer 15

1. Retinal hemorrhages
2. Corneal abrasion
3. Hyperemia (blood within anterior chamber)
4. Orbital floor fracture

Question 16

Retinal hemorrhage suggestive of? Other etiologies?

Answer 16

Child-abuse; increased ICP, hypertension, endocarditis, birth trauma, leukemia

Question 17

Hyphema – definition? causes? Clinical features? Complications?

Answer 17

Blood in anterior chamber of eye

1. Blunt trauma
2. Non-traumatic – neovascularization, tumors
3. Impaired vision
4. blood-aqueous fluid level

Rebleeding 3 to 5 days after injury, glaucoma, optic nerve damage (and sickle cell)

Question 18

Findings in orbital floor fracture?

Answer 18

1. Diplopia (from entrapment of inferior rectus muscle), strabismus
2. Numb cheek and teeth (Infraorbital nerve injury)

Question 19

Normal intraocular pressure in infants? In infants with congenital glaucoma?

Adult glaucoma versus congenital glaucoma?

Answer 19

10-15; >30

Increased intraocular pressure the damages optic nerve

versus

injures optic nerve and expands the size of eye (Results in corneal edema, corneal clouding, amblyopia)

Question 20

Mechanism for increased Intraocular pressure in congenital glaucoma? Causes of congenital glaucoma?

Answer 20

Reduced outflow of aqueous humor because of maldevelopment of trabecular meshwork

1. Infection – congenital rubella
2. Ocular abnormalities – aniridia
3. Genetic syndromes – Sturge-Weber, neurofibromatosis, Marfan

Question 21

Clinical features of congenital glaucoma? Management?

Answer 21

Tearing, photophobia, enlarged cornea, corneal clouding, dull-red reflex

Surgery almost always required. Beta-adrenergic and carbonic anhydrase inhibitors may help to lower intraocular pressure

Question 22

Retinopathy of prematurity? Risk factors? Management? Prevention?

Answer 22

Proliferation of vessels in premature infants exposed to oxygen

High oxygen exposure, low birth weight, transfusions, surfactant deficiency, intracranial hemorrhage

If severe, retinal cryotherapy and laser therapy

1. Minimizing oxygen delivered and effective treatment of highland membrane disease
2. Premature infants should have eye exam at 5 weeks

Question 23

Causes of congenital cataracts? Prognosis?

Answer 23

1. Genetic – down, Noonan, Marfan, Alport
2. Metabolic – hypoglycemia, galactosemia, diabetes
3. Infection – CMV, rubella

Surgery performed over two months of age is associated with poor visual outcome

Question 24

Retinoblastoma – age? Chromosome? Two most common presenting signs? Hallmark of retinoblastoma? Clinical signs? Treatment of very small tumors? Small tumors? Large tumors?

Answer 24

13-18 months; chromosome 13 Leukocoria and strabismus Calcification within the tumor Glaucoma, vitreous hemorrhage, retinal detachment, hyphema 1. Cryotherapy or laser photocoagulation 2. External beam radiation 3. If it involves macula – remove whole eye

Question 25

Leukocoria? Suggestive of?

Answer 25

White pupil – suggest opacity at/behind pupil 1. Cataract 2. Retinoblastoma 3. Opacity within the vitreous

Question 26

Strabismus? Types?

Answer 26

Misalignment of the eyes 1. Esotropia – eye turned nasally 2. Exotropia – eye turned laterally 3. Vertical 4. Pseudostrabismus – Prominence of epicanthal folds result in false appearance of strabismus

Question 27

Strabismus in pt under six years versus over six years? Tx?

Answer 27

Child suppresses image in deviated eye (resulting in amblyopia) versus unable to suppress image in Deviated eye (resulting in diplopia) 1. Patching 2. If associated with farsightedness, Initially treated with corrective lenses 3. Surgery if no response