Rosen's 10th > Ophtho > Flashcards

Ophtho Flashcards

(139 cards)

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1
Q

List 6 findings of acute hypertensive retionopathy

A
  • focal intraretinal periarteriolar transudates
  • focal retinal pigment epithelial lesions
  • macular edema
  • optic disk edema
  • cotton wool spots
  • hard exudates
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2
Q

List 4 findings of chronic hypertensive retinopathy

A
  • arterial narrowing
  • copper or silver wiring of the arterioles
  • arteriovenous nicking
  • retinal hemorrhages
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3
Q

Outline Funduscopic Grading of Suspected Hypertensive Retinopathy

A

Grade 0
- normal

Grade 1
- minimal arterial narrowing

Grade 2
- obvious arterial narrowing w/ focal irregularities

Grade 3
- arterial narrowing w/ retinal hemorrhages and/or exudate

Grade 4
- arterial narrowing, retinal hemorrhages, hard exudates, disk swelling

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4
Q

Outline mgmt of ocular alkali exposures

A

= True Ophtho Emergency

Immediate irrigation w/ 2L NS per eye
- except in case of frank perforation

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5
Q

List 4 features of isolated CN III palsy

A

Diplopia in all directions, except ipsilateral lateral gaze

Eye deviated down + out

Ptosis

Dilated pupil

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6
Q

List features of isolated CN IV palsy

A

Vertical or Torsional diplopia

Worsens on looking down + toward nose

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7
Q

List features of isolated CN VI palsy

A

Affected eye turns inward

Diplopia worsens on lateral gaze toward ipsilateral side

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8
Q

List clinical features of Cavernous Sinus or Orbital Apex Syndromes

A
  • Ipsilateral diplopia involving CN III, IV and/or VI
  • Pain
  • Exophthalmos
  • Chemosis
  • Ipsilateral periorbital facial numbness or dysesthesia (CN V)
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9
Q

List 3 causes of Structural Orbitopathy that lead to Binocular Diplopia

A

Trauma
Infection/abscess
Craniofacial masses

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10
Q

List 8 causes of Orbital Myositis that lead to Binocular Diplopia

A
  • Thyroid eye disease
  • GPA
  • GCA
  • SLE
  • Dermatomyositis
  • Sarcoidosis
  • RA
  • Idiopathic orbital inflammatory syndrome (orbital pseudotumour)
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11
Q

List 6 causes of Isolated Oculomotor Nerve Palsies that lead to Binocular Diplopia

A
  • Multiple sclerosis
  • Hypertensive vasculopathy
  • Diabetic vasculopathy
  • Idiopathic intracranial hypertension
  • Compression
  • Trauma
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12
Q

List 5 causes of Multiple Oculomotor Nerve Palsies

A
  • Cavernous sinus infection
  • Cav sinus mass
  • Cav sinus vasculitis
  • Cavernous sinus thrombosis
  • Orbital apex syndrome
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13
Q

List 2 Neuromuscular Disorders causing Binocular Diplopia

A

Myasthenia gravis
Botulism

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14
Q

List 8 neuroaxial processes involving the brainstem and related cranial nerves, that lead to binocular diplopia

A

Focal:
- Multiple sclerosis

Localized brainstem process:
- Tumour
- Stroke
- Hemorrhage
- Basilar artery thrombosis
- Vertebral artery dissection
- Ophthalmoplegic migraine

Diffuse (involving brainstem and/or CNs III, IV, VI):
- Infectious = basilar meningoencephalitis
- Autoimmune = Miller-Fisher or GBS
- Metabolic = Wernicke encephalopathy

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15
Q

List 7 causes of cerebral diplopia (polyopia)

A
  • Stroke
  • Vascular spasm
  • Tumour
  • MS
  • Trauma
  • CNS Infections
  • Seizures (occipital or temporal lobes)
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16
Q

List 6 DDx of Monocular Diplopia

A

Dry eyes

Corneal irregularity

Cataract

Lens dislocation

Retinal wrinkles

Conversion disorder

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17
Q

List 3 CNs responsible for EOM, and name the EOM muscles

A

III = Oculomotor
IV = Trochlear
VI = Abducens

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18
Q

List 4 critical (life threatening) causes of diplopia

A

Basilar artery thrombosis
- vertigo, dysarthria, other CNs involved

Botulism
- dysarthria, dysphagia, autonomic dysreflexia, pupillary dysfunction

Basilar meningitis
- HA, meningismus, fever

Aneurysm
- CN III palsy w/ pupillary involvement

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19
Q

List 5 emergent causes of diplopia

A

Vertebral artery dissection

Myasthenia gravis

Wernicke encephalopathy

Orbital apex syndrome

Cavernous sinus process

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20
Q

List 5 urgent causes of diplopia

A

Brainstem tumour

Miller Fisher syndrome

MS

Graves disease (thyroid myopathy)

Ophthalmoplegic migraine

Ischemic neuropathy

Orbital myositis, pseudotumor

Orbital apex mass

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21
Q

What test should correct a monocular diplopia?

A

Looking through a pinhole

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22
Q

Diagnosis?

A

Acute central retinal artery occlusion

  • pale and edematous retina
  • cherry red spot
  • retinal veins intact
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23
Q

List 7 ‘red flag’ clinical features of red or painful eyes, likely to have serious diagnoses

A

Severe ocular pain

Persistently blurred vision

Exophthalmos (proptosis)

Reduced ocular light reflection

Corneal epithelial defect or opacity

Limbal injection (ciliary flush)

Pupil unreactive to a direct light stimulus

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24
Q

List 5 causes of a foreign body sensation in the eye

A

foreign body
corneal abrasion
corneal ulcer
viral keratitis
ultraviolet keratitis

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25
List 3 causes of itchy eye
blepharitis conjunctivitis dry eye syndrome
26
List 5 causes of burning eye
- blepharitis - conjunctivitis - dry eye syndrome - irritation of a pterygium or pinguecula - episcleritis - limbic keratoconjunctivitis
27
List 5 causes of dull pain to the eye
Acute angle closure glaucoma Endophthalmitis Sinusitis Migraine HA Temporal arteritis
28
Outline complete eye exam
= VVEEPP Visual acuity - best possible using correction Visual fields - tested by confrontation External examination - Globe position in orbit - Conjugate gaze - Periorbital soft tissues, bones, and sensation Extraocular muscle movement Pupillary evaluation - absolute & relative Pressure determination - tonometry + Slit-lamp examination + Funduscopic examination
29
In testing visual acuity, what should be used if a pt does not have their glasses/lenses w/ them?
Use pinhole cover
30
List general levels of visual acuity
Reading of Snellen chart - or other printed material then, Unable/able to count fingers (CF) Unable/able to perceive hand motion (HM) Unable/able to perceive light (LP)
31
List 6 causes of exophthalmos
- Retrobulbar hematoma - Any orbital compartment syndrome - Orbital cellulitis - Intraorbital tumour - Lacrimal tumour - Hyperthyroidism - Orbital emphysema 2/2 retained FB
32
List 4 causes of conjunctivitis in the neonate
Chemical conjunctivitis (24-36hr) HSV Neisseria gonorrhoeae (2-5d) C. trachomatis (5-12d)
33
List 6 causes of anisocoria
Physiologic Ophthalmoplegic migraine Topical medications Globe injury Abnormalities of afferent or efferent nerves Ciliaris paralysis Sphincter pupillae muscle paralysis Uveitis Narrow angle glaucoma
34
What is normal IOP
10-20mmHg
35
List 3 causes of intraocular HTN
Glaucoma Suprachoroidal hemorrhage Space-occupying retrobulbar pathology
36
List 8 Causes of Inability to Visualize a Red Reflex or the Otic Fundus
Opacification of cornea - commonly edema 2/2 injury or infection Hyphema Hypopyon Extremely miotic pupil Cataract of lens Blood in vitreous or posterior eye wall Retinal detachment Intraocular mass - retinoblastoma
37
List 6 traumatic injuries visible w/ ocular U/S
- retinal detachment - lens dislocation - intraocular foreign body - globe rupture - retrobulbar hematoma - vitreous hemorrhage
38
Outline algorithm for red and painful eye
39
Diagnosis?
HSV dendrite
40
List 2 infectious causes of conjunctivitis w/ hyperpurulent discharge
Chlamydia Gonorrhea
41
Outline mgmt of caustic injury to the eye
Immediate & copious irrigation w/ tap water or sterile RL until tear-film pH = 7 Solids: Lift particles out w/ dry swab before irrigation Acids: Min 2L & 20min Alkalis: Min 4L & 40min Ophtho consult IN ED if abnormal visual acuity or exam after sufficient irrigation - exception is injection of conjunctiva Otherwise Ophtho f/u in 1-2d
42
List clinical features of orbital compartment syndrome
Exophthalmos (proptosis) Decreased visual acuity Painful or limited EOM Increased IOP
43
What IOP measurement necessitates lateral canthotomy in ED?
>30mmHg
44
Outline mgmt of penetrating injury to the globe/ruptured globe
Protect eye from pressure Analgesia Prevent vomiting/Anti-emetics Cefazolin 1g IV or Vancomycin 1.5g IV PLUS Moxifloxacin IV Tetanus booster Ophtho consult IN ED
45
List clinical features of penetrating injury to the globe
Localized redness at site of entry Teardrop pupil Blood in anterior chamber Loss of red reflex
46
List clinical features of hyphema
Pain Decreased visual acuity Gross or microscopic blood in anterior chamber Dilated + fixed pupil following blunt trauma Graded by amount of blood: - % vertical diameter of anterior chamber w/ pt in upright position - Microhyphema shows no layering, only suspended RBCs
47
Outline mgmt of corneal perforation
Protect eye from pressure Analgesia Prevent vomiting/Anti-emetics ABX + tetanus booster Ophtho consult IN ED
48
Outline mgmt of corneal abrasion
ABX ppx - polymyxin-B/trimethoprim sol'n 1 drop q3h while awake - erythromycin ointment while sleeping If contact lens wearer - consider fluoroquinolone F/u Ophtho in 1-3d
49
List clinical features of inflammatory pseudotumour of the eye
- Nonspecific idiopathic retrobulbar inflammation - Eyelid swelling - Palpebral injection of conjunctiva - Chemosis - Proptosis - Blurred vision - Painful or limited EOM - Binocular diplopia - Edema of optic disk - Venous engorgement of retina
50
List COMMON clinical features of periorbital & orbital cellulitis
- Eyelid swelling - Redness & warmth of skin overlying orbit - Tenderness of skin overlying bone - Palpebral injection of conjunctiva - Chemosis
51
Contrast periorbital & orbital cellulitis
Orbital cellulitis is present w/ ANY of: - fever - ill toxic appearance - blurred vision - proptosis - painful or limited EOM - binocular diplopia - edema of optic disk - venous engorgement of retina Periorbital cellulitis has NONE of above
52
Diagnosis?
Dacryocystitis
53
List clinical features of Dacryocystitis
- Eye tearing & inflammation of lower eyelid inferior to lacrimal punctum - Redness & tenderness over nasal aspect of lower lid & adjacent periorbital skin - Purulence can be expressed from puncta
54
Outline mgmt of Dacryocystitis and Dacryoadenitis
PO analgesics and ABX - AmoxClav Apply warm compresses to eyelid x15min Gently massage inner canthal area QID
55
Diagnosis?
Stye = Hordeolum
56
Outline clinical features of Hordeolum (stye)
Abscess in eyelash follicle or modified sebaceous gland at lid margin - may be internal or external - may express purulence Usually S. aureus
57
Outline mgmt of Hordeolum (Stye)
External - Warm compresses x15min, massage QID - anti-Staph ointment BID Internal - AmoxClav PO Can refer to outpt Ophtho is tx failure after 2weeks
58
Define chalazion
Inflammation of meibomian gland causing subcutaneous nodule within the eyelid Usually painLESS
59
List clinical features of narrow angle glaucoma
Sudden-onset eye pain Blurred vision Frontal headache N/V Pupil fixed at midsize Limbal injection of conjunctiva
60
Outline mgmt of acute angle closure glaucoma
Administer medications in ED if IOP >30 Decrease production of aqueous humour: - Prostaglandins (latanoprost 0.005%—1 gtt) - Timolol 0.5% 1 drop - Apraclonidine 1% 1 drop - Dorzolamide 2% 1 drops (if Sickle Cell dz or trait, then Methazolamide 50mg PO) - Acetazolamide 500 mg IV or PO Decrease inflammation: - Prednisolone 1% 1 drop q15min x4, then q1h Constrict pupil: - Pilocarpine 1%–2% 1 drop after IOP <50 - repeat q15min Consider establishing osmotic gradient: - Mannitol 2 g/kg IV May need surgical laser peripheral iridotomy
61
Outline tx of HSV keratitis
Acyclovir 5% ointment 5x/d x7d - Then taper over 2weeks PO NSAIDs analgesia
62
List clinical features of Anterior uveitis +/- hypopyon
- Eye pain - Photophobia - Tearing - Limbal injection of conjunctiva - Cells or flare in anterior chamber - Hypopyon is layering of WBC/pus in anterior chamber
63
Outline mgmt of Anterior Uveitis
Prednisolone acetate 1% drops Cycloplegics F/u w/ Ophtho in 2-3d
64
Outline mgmt of hyphema
HOB >30 Analgesia Antiemetics Can give long-acting cycloplegic agent - prevent repetitive motion of iris Rigid eye shield during sleep Ophtho consult
65
List 5 indications for admission w/ hyphema
- Large hyphemas >50% - Increased IOP - Hx sickle cell trait or dz - Hx coagulopathy - Difficulty adhering to outpt tx
66
Outline 4 eyelid lacerations that require referral to plastic or ophthalmic surgeon
Lid margin lacerations Canalicular laceration Levator tendon injury Canthal tendon injury
67
What route of ABX administration is required in Endophthalmitis?
Intravitreal ABX
68
Describe positive Seidel's test
fluorescein dye on the conjunctival surface is focally displaced by leakage of non-fluorescent aqueous fluid
69
Outline mgmt of conjunctival lacerations & scleral lacerations
Conjunctival: - Topical ABX ppx x3-5d - Consult Ophtho in ED for lacs >1cm Scleral: - Tx as globe perforation - Ophtho in ED
70
List 5 signs of open/ruptured globe injury
Loss of anterior chamber depth Prolapsed iris Irregular or Teardrop pupil Blood in anterior chamber 360' subconjunctival hemorrhage (+) Seidel's test
71
Diagnosis?
Corneal laceration w/ prolapse of iris + teardrop pupil
72
Outline pts at risk for Pseudomonal infxn of corneal abrasions, and ABX coverage to prescribe
- Contact lens wearers - Immunocompromised pts Rx: - Tobramycin - Ciprofloxacin 0.3% ointment 1cm ribbon QID x7d - Ciprofloxacin 0.3% sol/n 1-2 drops QID x7d - Moxifloxacin 0.5% sol'n 1-2 drops TID x7d - Gentamicin 0.3% ointment 1cm ribbon BID x7d - Gentamicin 0.3% sol'n 1-2 drops QID x7d - Ofloxacin 0.3% sol'n 1-2 drops QID x7d
73
List 3 predisposing factors for a lens dislocation
Marfan’s syndrome Homocystinuria Myopia
74
List indications for a cycloplegic in eye trauma
- Large hyphema - Traumatic iritis - Cyclodialysis - Iridodialysis
75
List clinical features of retinal detachment
Floaters Flashes of light = Photopsia Curtain-like blocking of vision NO pain
76
List 2 most common areas of scleral laceration
Muscle insertion sites Limbus aka thinnest areas
77
Define sympathetic ophthalmia
Vision-threatening autoimmune response to remaining healthy eye triggered by exposure of previously naïve immune system to intraocular contents from ruptured eye.
78
List 5 DDx for painLESS vision changes
CRAO CRVO Retinal detachment Carotid artery embolus Retinal arteritis/GCA Commotio retinae
79
List clinical signs of acute orbital wall fracture
- ecchymoses - tissue swelling - hypesthesia of trigeminal nerve - double or blurry vision - enophthalmos - ptosis
80
Outline triad of retrobulbar HEMORRHAGE
1. Proptosis 2. Ophthalmoplegia 3. Altered vision
81
Describe oculocardiac reflex
- rare complication of an orbital fracture or retrobulbar injury - pressure exerted on periorbital tissue sends afferent signal via trigeminal nerve - efferent signal sent to vagus nerve, triggers bradycardia, jnc/l rhythm, asystole, n/v
82
Outline clinical features of retrobulbar HEMATOMA
Presence of 3+ of following: - pain - decreased vision - proptosis w/ resistance to retropulsion - chemosis - limited EOM - diplopia - diffuse subconjunctival hemorrhage - increased IOP - APD
83
List clinical features of optic nerve injury
- decrease in visual acuity - visual field defect - RAPD (Marcus Gunn pupil) - change in appearance of optic nerve
84
Outline mgmt of orbital wall fracture
PPX ABX - especially if into sinuses No Valsalva or nose blowing Nasal decongestants Ice packs to orbit x48hr
85
List 4 clinical indications for surgical exploration of orbital wall fractures
Pediatric trapdoor fractures CT evidence of entrapment w/ diplopia Gaze restriction Non-resolving oculocardiac reflex
86
List temporizing medications in situations of increased IOP w/ retrobulbar hemorrhage/hematoma
Carbonic anhydrase inhibitors IV Topical beta-blockers Topical alpha agonists Mannitol 1-2g/kg IV
87
List clinical signs of potent chemical exposure to the eye
- periorbital edema - periorbital erythema - de-epithelialized skin - loss of eyelashes & eyebrows - corneal and conjunctival epithelial defects - chemosis - corneal cloudiness - sterile ulceration - conjunctival edema - corneal/conjunctival perforation
88
Outline ocular pH goal
7-7.5
89
List 5 complications of chemical exposures to the eye
Permanent corneal injury Glaucoma Palpebral & Conjunctival adhesions Cataracts Retinal injury
90
List sources of UV exposure & UV keratitis to the eye
Tanning booths Snow or Water reflections Welder's arc - latency of 6-10hrs before symptoms
91
Define Pterygium and Pinguecula
Pterygium - chronic inflammatory fibrovascular hypertrophy of conjunctiva - chronic UV exposure - grows from one side to other - can cross the limbus, cover cornea Pinguecula - similar to pterygium, but does NOT cross limbus or visual axis
92
List 4 seronegative arthritides that have uveitis as an extra-articular complication
Ankylosing spondylitis Psoriatic arthropathy Arthritis 2/2 IBD Reactive arthritis
93
List 10 systemic diseases associated with scleritis
Connective Tissue Dz: - RA - Reactive arthritis - SLE Systemic Vasculitides: - GPA - MPA - EGPA - Polyarteritis nodosa - Behçet syndrome - Urticarial vasculitis Infections: - Syphilis - TB - Lyme - VZV - Aspergillis Other: - Sarcoid - IBD
94
List 5 systemic diseases associated w/ Orbital inflammatory pseudotumor
GPA GCA SLE Dermatomyositis RA
95
List 5 systemic diseases associated w/ orbital apex syndrome
Infection Carotid-cavernous fistula GCA Tolosa-Hunt syndrome Tumour Sarcoidosis
96
List tx for orbital pseudotumour
Systemic corticosteroid tx
97
What type of reaction is allergic conjunctivitis?
Type 1 histaminergic hypersensitivity reaction
98
Name most common cause of viral conjunctivitis
Adenovirus
99
Name 5 most common causes of bacterial conjunctivitis
S. aureus MRSA Moraxella catarrhalis Strep pneumoniae Haemophilus influenzae Neisseria gonorrhoeae
100
List topical ABX for ophtho infections
Erythromycin 0.5% ointment 1cm ribbon QID x7d Polymyxin B/Trimethoprim solution 1 drop QID x7d Sulfacetamide 10% solution 1-2 drops QID x7d Azithromycin ophthalmic 1% sol/n 1 drop BID x2d, then OD x5d
101
Outline tx for gonorrheal conjunctivitis
CTX 1g IM/IV x1 Saline irrigations +/- Chlamydia coverage = Doxycycline 100mg PO BID x7d
102
Outline tx of Ophthalmia neonatorum
GONORRHEA: - CTX 50mg/kg IM/IV x1 and - Erythromycin ointment CHLAMYDIA: - Erythromycin syrup 50mg/kg/d PO divided QID x14d and - Erythromycin ointment HSV: - Acyclovir 20mg/kg IV q8h and - Vidarabine 3% ointment 5x/d x14d ALL: - Saline irrigation of eyes
103
Outline mgmt of corneal ulcers
Topical moxifloxacin - may use steroids but caution Ophtho consult in ED
104
Outline mgmt of HSV keratitis
TOPICAL: - Acyclovir trifluridine 1% 9x/d x14d - Ganciclovir 0.15% gel QID - Trifluridine 1% sol/n 5x/d x14d SYSTEMIC: - Acyclovir - Valacyclovir Ophtho consult in ED
105
Outline mgmt of VZV keratitis
Herpes zoster ophthalmicus Acyclovir 800mg PO 5x/d Valacyclovir 1000mg PO TID Ideal tx start w/in 72hr of rash Analgesia Dry eye lubrication Topical anti-bacterial to prevnet superinfection
106
Diagnosis?
Dacryocystitis
107
List 5 predictors of orbital abscess
- ANC >10,000 cells/μL - Moderate-to-severe periorbital edema (beyond eyelid margins) - Absence of conjunctivitis as presenting symptom - Age >3yr - Recent ABX use
108
List 6 most common causative organisms in dacryocystitis
S. aureus MRSA S. pneumoniae H. influenzae Serratia marcescens Pseudomonas aeruginosa
109
List findings of endophthalmitis in U/S
Numerous heterogeneous strands & membranes in a vitreous that should be hypoechoic
110
Briefly describe pre-chiasmal vision loss
- Monocular decreased visual acuity or visual field loss - Ipsilateral optic nerve affected - Ipsilateral RAPD
111
Briefly describe chiasmal and post-chiasmal vision loss
- Preserved visual acuity - Visual field loss in both eyes that respects midline
112
List clinical features of optic neuritis
- Autoimmune inflammatory process of optic nerve - Monocular blurring or fogginess of vision evolving over hr-days - Variable degrees of pain w/ EOM of affected eye - Vision worse w/ increased body temperature
113
List 8 causes of a toxic visual disturbances
Methanol Ethylene glycol Ethambutol Chloramphenicol Barbiturates Hypervitaminosis A INH Heavy metals
114
List 6 causes of papilledema
ICH SAH IIH Cryptococcal meningitis Hydrocephalus Intracranial mass
115
List 7 DDx for optic neuritis
MS Syphilis Lyme HIV VZV Cat-scratch disease Sarcoidosis
116
List 3 causes of vitreous hemorrhage
DM retinopathy Retinal tears Neovascularization
117
Outline 3 mechanisms of retinal detachment
1) Rhegmatogenous - Tear in inner neuronal layer of retina, vitreous fluid leaks in - Usually age >45, male - Associated w/ degenerative myopia, or trauma at any age 2) Exudative - Fluid or blood leakage from vessels w/in the retina - Associated w/ HTN, Pre-eclampsia, CRVO, Glomerulonephritis, Papilledema, Vasculitis, Choroidal tumour 3) Tractional - Contraction of a fibrous band that has formed in vitreous
118
Diagnosis?
Vitreous hemorrhage
119
Diagnosis?
Retinal detachment
120
Diagnosis?
Retinal detachment
121
Name classic visual defect for a lesion in/compression of the optic chiasm
Bitemporal hemianopsia
122
Name classic visual field defect in post-chiasmal (cerebral or cortical) disease
Homonymous hemianopsia = visual field loss on the same side of both eyes
123
List 3 types of CRAO
1) Non-arteritic & Permanent = Ischemic stroke of retina 2) Non-arteritic & Transient = TIA of retina 2/2 vasospasm 3) Arteritic = Temporal arteritis
124
List risk factors for CRAO
Age 50-70 Vascular risk factors (HTN, DM, DLD) Collagen vascular dz Vasculitis Cardiac valvulopathy Sickle cell dz Pts w/ increased orbital pressure 2/2 acute glaucoma, retrobulbar hemorrhage, endocrine exophthalmos
125
List 3 fundoscopic findings in CRVO
= Blood + Thunder - Dilated & tortuous veins - Retinal hemorrhages - Disk edema
126
List 2 major complications of CRVO
Neovascular glaucoma Macular edema
127
List 6 risk factors for ischemic CRVO
HTN DLD DM Vasculitides Hyperviscosity syndromes Smoking
128
List 5 precipitants of Non-Arteritic Ischemic Optic Neuritis (NA-AION)
Anemia Hypovolemia Dehydration Systemic hTN Fluctuations in BP - especially during HD
129
Outline mgmt of CRAO
Nothing is exactly good/efficacious! Can try: - Direct digital pressure thru closed eyelids x10-15s, then sudden release - Inhaled carbogen (95% O2 + 5% CO2) to dilate artery - Anterior chamber paracentesis - HBOT - IV thrombolysis w/in 4.5hr of onset - Topical beta blockers
130
Outline mgmt of CRVO
Consult Ophtho in ED LMWH anti-thrombotics Anti-VEGF pharmacotherapies Intravitreal injections of corticosteroids or antiangiogenic monoclonal antibodies Retinal photocoagulation Cyclocryotherapy
131
Outline mgmt of temporal arteritis w/ vision loss/amaurosis fugax (A-AION)
Admit pts Methylprednisolone 1g IV q24h x3d
132
List 4 general causes of binocular diplopia
1) Restrictive, mechanical orbitopathy 2/2 infxn or inflammation 2) Oculomotor CN palsy(ies) 3) Neuro-axial process involving brainstem & related CNs 4) Neuromuscular process
133
List 8 causes of Adie's tonic pupil
Ciliary ganglion lesion - 2/2 Sx, Trauma, Infxn, Inflammation, Ischemia Systemic autonomic dysfunction - 2/2 DM, Dyautonomia, Neurosyphilis, Amyloid, Sarcoid
134
List DDx of lesions causing Horner Syndrome (ptosis, miosis, facial anhidrosis)
Brainstem infarct Brainstem neoplasm Demyelinating process Neoplastic Spinal cord syndrome Pancoast tumour Mediastinal tumour Carotid dissection Accidental carotid injection of local anesthetic in dental or line-placement procedures Skull base neoplasm or mass Neuroblastoma
135
List 8 DDx for causes of Argyll Robertson pupils
Neurosyphilis DM Neurosarcoidosis Chronic alcoholism Encephalitis MS Lyme disease VZV
136
Define nystagmus
repetitive horizontal, vertical, or torsional back and forth movement of the eyes
137
List peripheral causes of nystagmus
Labyrinthitis Vestibular neuronitis BPPV posterior canal BPPV horizontal canal
138
List 10 metabolic and toxic causes of nystagmus
Lithium Phenytoin Carbamazepine Alcohol Toluene Lamotrigine Phencyclidine (PCP) Ketamine Dextromethorphan LSD Magnesium deficiency Vit B12 deficiency Thiamine deficiency
139
List 3 bacterial causes of Orbital Cellulitis
S. aureus S. anginosus S. pyogenes H. influenzae Uncommonly: Fusobacterium Peptostreptococcus Pseudomonas Klebsiella
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