Optho Flashcards

Question

Pupillary light reflex

Answer 1

* constriction of both pupils in reponse to light * CONSTRICTION (miosis) * sensory portion: _CN II_, retina, optic nerve, optic chiasm, optic tract to midbrain * Motor portion: _parasympathetic innervation_ via both oculomotor nerves **CNIII** to both sides of iris * DILATION (mydriasis) * motor: _sympathetic innervation_ via **CN V** *

Answer 2

asymmetric pupil can be variant or pathological

Answer 3

sleep and wake cycle

Answer 4

sleep and wake cycle

Answer 5

visual reflexes

Answer 6

**impaired distance vision** * impaired distance vision * aka "nearsightedness" * when you have an _elongated eyeball_ * treated with a **concave lense**

Answer 7

**impaired near vision** * "farsightedness" * when you have a _short eyeball_ * treated with a **convex** lense

Answer 8

* type of **hyperopia** (loss of near vision) due to aging

Answer 9

normal vision

Answer 10

* incorrect development of the eye's drainage system before birth * sxs: enlarged eyes, cloudiness of the cornea, and photosensitvity **autosomal recessive inheritance**

Answer 11

* clouding of the lens of the eye * part of many birth defects * Most important: * non-dysjunctions * Down syndrome (trisomy 21) * Trisomy 13

Answer 12

a group of progressive, visually debilitating diseases * lead to blindness caused by mutations in genes that cause photoreceptor cell death and associated vision loss * include: **retinitis pigmentosa** * inherited 3 ways: autosomal dominant, autosomal recessive and X-linked recessive

Answer 13

* autosomal dominant and autosomal recessive inheritance

Answer 14

most common form of uveitis * inflammation of the iris * s/sxs: **ciliary flush, miosis,** photophobia, and severe throbbing pain * unilateral, blurred or decreased vision * tx: topical steroid drops

Answer 15

uvea = choroid, ciliary body + iris * s/sxs: **blurred** or **decreased vision** due to _problems with blood flow_ (in the choroid), unilateral * tx: **systemic glucocorticoids**

Answer 16

inflammation of the episclera * s/sxs: distinguished from scleritis by **lack of severe pain & lack of photophobia** * mild irritation of the palpebral conjuctiva * diagnosis: slit lamp exam, blanching with phenylephrine * tx: supportive care * **systemic NSAIDs**

Answer 17

inflammation that involves the sclera and deep episclera * women age 30-50 with *connective tissue disease* * _s/sxs:_**deep, boring ache**, photophobia, unilateral, focal or diffuse eye redness * can have **nodular** or **necrotizing** * _diagnosis:_ clinical with slit lamp * _tx:_ systemic corticosteroids and/or systemic immunosuppresive therapy (consult rheum AND ophtho)

Answer 18

inflammation of the cornea * if bacterial: * **staph, pseudomonas** * _risk factors_: Bells palsy (dry eye surfaces) and improper contact lens use * _s/sxs_: **sudden pain in the eye**, redness, reduced vision, photophobia, **ciliary injection, hazy cornea**, conjunctival erythema * _diagnosis_: * clinical, slit lamp, fluorescein * _tx:_ topical **fluoroquinolones** (moxifloxacin) * DO NOT PATCH

Answer 19

infection/inflammation of the inner eye * usually caused by *staph epidermidis* or *staph aureus* * usually after surgery or penetrating ocular trauma * s/sxs: **intense conjunctival hyperemia**, loss of red light reflex, eyelid edema, **hypopyon, ocular pain, vision loss** * tx: * intravitreal abx, maybe add IV abx

Answer 20

variable curvature of the cornea or lense → difficult to focus light * s/sxs: headache, eyestrain, distorted or blurred vision at any distance * tx: **cylindrical lense** to correct shape

Answer 21

"nearsightedness" * point of focus is in front of retina b/c eye is too long or lense is too curved * can see near objects but not far objects * _dx_: visual acuity testing * _tx:_ **concave lense**

Answer 22

"farsightedness" * point of focus is behind the retina b/c the eyeball is too short or the lense is too flat * can see distant objects but not near ones * _dx_: visual acuity testing * _tx:_ convex lens

Answer 23

misalignment of one or both eyes * stable ocular alignment not usually reached until ag 2-3mo, still persisting at 4-6 months? refer * types: hypertropia (upward), hypotropia (downward), esotropia (inward), exotropia (outward) * _dx_: cover-uncover test * _tx:_ **patch the normal eye**, eyeglasses, corrective surgery if severe

Answer 24

increase IOP leading to damage of the optic nerve (**emergency**) * _risk factors_: hyperopia, \>60yo, asian, hyperopia, females, narrow angle or large lens * _s/sxs_: **sudden** onset of **severe ocular pain**, **unilateral**, halos around lights and tunnel vision (**loss of peripheral vision**) * N/V, HA * _dx_: tonometry (IOP\>21mmHg), optic disc blurring * _tx:_ combination of topical agents (**timolol, apraclonidine, pilocarpine**) + systemic agents (**PO/IV acetazolamide** or IV mannitol) * topical beta blockers * alpha 2 agonists (*aproacloonidine, brimonidine*) * miotics/cholinergics (*pilocarpine, carbachol*) * prostaglandins (*latanoprost*) * _definitive tx_: **iridotomy**

Answer 25

* **slow, progressive _painless, bilateral_ peripheral vision loss** * _risk factors_: AFrican American, \>40yo, family history, DM * s/sxs: usually **asymptomatic** until late into onset * **tunnel vision** progressing to central vision loss * _physical exam_: **cupping of optic disc** (increased cup to disc ratio) [larger cup inside the disc] * tx: **prostaglandin analogs** (1st line) **latanoprost**, * beta blockers (timolol) * alpha 2 agonists (brimonidine, apraclonidine) * carbonic anhydrase inhibitor (acetazolamide) * laser therapy * surgery = last line

Answer 26

decreased visual acuity of one eye due to disuse during visual development * \*\*needs to be **treated before age 8** if you want to avoid SEVERE vision loss\*\* * _risk factors_: strabismus, refractive errors (astigmatism, myopia, hyperopia), congenital cataract * _s/sxs_: decreased visual acuity * _diagnosis_: early screening * _tx_: eyeglasses, patch the normal eye, cataract removal, tx of strabismus, atropine drops

Answer 27

transient monocular vision loss that lasts minutes and spontaneously recovers * usually a retinal ischemia or emboli, TIAs, giant cell arteritis, migraine, lupus * _risk factors_: DM, heart disease, smoking, HTN, hyperlipidemia, age, cocain use * _s/sxs_: vision loss that descends over the visual field (often described as a **curtain or shade**) that usually resolves **within the hour** * _dx:_ clinical diagnosis * _tx_: tx the underlying vascular issue

Answer 28

* _risk factors_: associated with Afib and carotid disease * HTN, advancing age, glaucoma, DM * _s/sxs_: **sudden onset, severe, painless _unilateral_ vision loss** * blood and thunder of the retina * _dx_: fundoscopy * _tx:_ globe massagem, refer to optho/ED * decrease IOP * tx HTN!

Answer 29

* _risk factors_: associated with Afib and carotid disease * HTN, advancing age, glaucoma, DM * _s/sxs_: **sudden onset, severe, painless _unilateral_ vision loss** * **cherry red spot on pale macula** * _dx:_ fundoscopy * _tx:_ globe massagem, refer to optho/ED * decrease IOP * tx HTN!

Answer 30

* can be associated with trauma * hemorrhage in pts with DM * _s/sxs_: complaints of mild vision loss, floaters, cobwebs or flashes of light * refer to optho

Answer 31

Hyphema blood in the anterior chamber of the eye * referral, eye shield

Answer 32

Hypopyon collection of neutrophils and fibrin in the anterior chamber of the eye * often associated with **endophthalmitis** * referall to surgery and intravitreal abx

Answer 33

**ophthalmologic emergency** * significant visual acuity impairment, diplopia * _dx_: r/o intraocular foreign body, check visual acuity * DO NOT TOUCH EYE * _tx_: ABCs, and stabilization * apply rigid shield cup, keep head elevated at 30-40 degrees (do NOT want to increase IOP) * **CT orbits if stable** * **immediate surgical referral**

Answer 34

fracture of the inferior floor of the orbit * "trap door" or "white-eye fracture" in children = elastic bones can snap shut on muscle or other tissue * _s/sxs_: decreased visual acuity, diplopia, eyelid edema * _dx_: CT scan = **teardrop sign** (herniation of the orbital fat inferiorly * _tx:_ nasal decongestant, avoid blowing nose or sneezing, corticosteroids * abx: **ampicillin-sulbactam**, or **clindamycin** * surgery if severe

Answer 35

gradual, bilateral, painless vision loss * most common cause of new, permanent vision loss in 20-74yos can have _non-proliferative_: microaneurysms, cotton wool spots, hard exudates, blot and dot hemorrhages or _proliferative retinopathy_: neovascularization, and maculoedema * _dx_: fundoscopy, vital signs * _tx_: non-proliferative = glucose control, laser treatment * proliferative = **VEGF inhibitors** (bevacizumab), laser photocoagulation, treatment, glucose control

Answer 36

* associated with malignant HTN (uncontrolled high blood pressure) * can be associated with _non-proliferative retinopathy_: microaneurisms, cotton wool spots, hard exudates, drussen bodies, **flame hemorrhages** * or _proliferative retinopathy_: neovascularization + maculoedema * _dx_: fundoscopy + vital signs * _tx_: tx the HTN!! * non-proliferative: laser treatment * proliferative: **VEGF inhibitors** (bevacizumab), laser photocoagulation

Answer 37

When retina separates from the choroid * _risks_: myopia, previous cataract surgery, advancing age, trauma * _s/sxs_: **sudden onset**, unilateral,, \*\*flashes of light\*\*, floaters, **spreading cutrain of darkness** * _dx_: fundoscopy or ocular u/s * _tx_: keep pt **supine** with head turned toward side of detachment * emergent referal to retinal specialist to seal the defect *

Answer 38

most common cause of permanent legal blindness in adults \>75yo * **dry (atrophic)**: most common type and progressive (spanning over decades) * **wet (neovascular or exudative**): occurs more rapidly and is more severe * _s/sxs:_ **bilateral** progressive **central vision loss,** * ****_central scotoma_, **metamorphopsia** (straight line appears bent) * _dx_: dry = _drusen bodies_ * wet = _new, abnormal vessels_ that can cause hemorrhaging and scarring * fundoscopy, **AMSLER GRID** * ****_management of dry_: zinc and vitamins C&E can slow progression * **_tx of wet_**: **intravitreal VEGF inhibitors** (bevacuzimab, ranicuzimab) = decrease new and abnormal vessel growth * laser photocoagulation

Answer 39

* _preseptal orbital cellulitis_ = outside of the orbit * _postseptal orbital cellulitis_ = inside the orbit (especially from sinus infection from the **ethmoid sinus** * _s/sxs_: * preseptal and postseptal = tenderness, edema, erythema, discoloration of eyelid and fever * postseptal = **decreased ocular mobility**, pain with eye movement, **proptosis**, and decreased visual acuity * _dx_: clinical, **high resolution CT scan** * _tx_: admission + IV abx * **vancomycin + ceftriaxone** or **cefotaxime** (3rd gen) * preseptal = outpatient if older than **_1 year_** oral **clindamycin** (to cover MRSA)

Answer 40

optic disc swelling associated with increased intracranial pressure * pressure of brain on optic nerve = swelling of optic disc * _s/sxs_: headache, nausea, **bilateral blind spots**, vision can be preserved * swollen optic disc with blurred margin * _dx_: fundoscopy, MRI or CT scan to r/o mass effect, lumbar puncture to test pressure of CSF * _tx_: **acetazolamide** (decreases production of aqueous humor and CSF production) [carbonic anhydrase inhibitor and diuretic] * tx the underlying cause

Answer 41

inflammation of the optic nerve often due to acute inflammatory **demyelination** of the optic nerve * associated with women 20-40yo, **multiple sclerosis**, and **ethambutol** * _s/sxs_: **unilateral, painful vision loss** * decrease in color vision, **central scotoma** over hours to a few days, ocular pain **worse with movement** * 1/3 of pts have papillitis ( optic disc swelling) * _dx_: clinical, MRI orbit, brain and spinal cord * **swinging flashlight test** * _tx_: IV corticosteroids (**methylprednisone**) followed by PO corticosteroids * neuro and optho referral

Answer 42

drooping of eyelid can be associated with CN III deficit or levator palpebrae muscle referral to optho

Answer 43

* aka exopthosis, protrusion of the eyeball * \*\*most common in adults with **Graves Disease** (hyperthyroid) * \*\*most common in children with **orbital cellulitis**\*\* * _s/sxs_: red flags = eyepain/redness, HA, loss of vision, diplopia, fever, pulsating or neonatal * _dx_: * acute unilateral = **infection** or **vascular disorder** * chronic unilateral = **tumor** * **CT, MRI** * order thyroid function testing * _tx_: lubricate the cornea, systemic corticosteroid to reduce edema * may need surgery

Answer 44

aka stye = abscess of the meibomian gland, gland of Moll, or Gland of Zeiss) * *staph aureus* * _s/sxs_: pain, warm, erythematous, nodule or pustule on eyelid * _diagnosis_: clinical * _tx:_ warm compresses, can use oral abx if accompanied by preseptal orbital cellulitis (**dicloxacillin** or **erythromycin**) * can add topical abx if actively draining (**erythromycin or bacitracin**)

Answer 45

**Entropion** inversion of the eyelid * usually associated with advancing age, but can also be postinfection, trauma, or blepharospasm * _s/sxs_: foreign body sensation, tearing, red eye * diagnosis is clinical * _tx:_ surgery = refer to optho

Answer 46

**Ectropion** * eversion of the lower eyelid * caused by advancing age, relaxation of tissue, cranial nerve VII palsy, and post-traumatic/surgical changes * _s/sxs_: tearing (because puncta are no longer in contact with the eye) dry eye * diagnosis is clinical * _tx_: lubrication eye drops at night * tear supplements * definitive tx = surgery, refer to optho

Answer 47

non-infectious blockage of internal Meibomian sebaceous gland, or zeiss gland * often associated with acne rosacea * _s/sxs_: **non-tender localized eyelid swelling** on the conjunctival surface of the eyelid * often larger, firmer, slower growing, and less painful than hordeolum * diagnosis is clinical * _tx:_ warm compresses, abx eye drops * referral to optho for injection of glucocorticoid or incision + curettage if does not resolve

Answer 48

infection of the eyelids * _acute ulcerative_: *staph or HSV* * _acute non-ulcerative_: allergic * _chronic_: meibomian gland dysfunction or seborrheic dermatitis * _s/sxs_: **pruritus or burning of eyelid margin**, conjunctival irritation and tearing, photosensitivity, sensation of foreign body * _dx_: slit lamp * _tx:_ supportive * warm compresses, cleansing of eyelid, keratoconjuctivitis sicca tx PRN * can use abx for acute ulcerative and chronic or topical corticostosteroid of nonulcerative

Answer 49

infection of the lacrimal sac * often caused by *staph aureus and strep* * _s/sxs_: pain, erythema, edema around lacrimal sac * pressure on lacrimal sac may **exude mucoid or purulent material through the puncta** * diagnosis is clinical * _tx_: mild = warm compresses and **1st gen ceph,** or **penicillinase-resistant penicillin** (PO) * IV abx * not responding to tx? consider MRSA

Answer 50

abx ointment (**aminoglycoside** tobramycin, gentamicin), or **erythromycin** and pupillary dilation plus the **tetanus immunization**!!!

Answer 51

benign growth of the conjunctiva that results from chronic actinic irritation * more common in sunny, dry, hot climates * _s/sxs_: **fleshy, trianngular growth** of the _bulbar conjunctiva_ that can spread across the cornea and induce astigmatism/affect vision * **pinguecula** doe NOT affect the cornea * diagnosis is clinical * _tx:_ arifical tears or short course of topical corticosteroids, reassurance * referral if starting to affect vision for surgery

Answer 52

corneal infection with HSV * _s/sxs_: ocular pain, foreign body sensation, photophobia, blurred vision, watery discharge * **dendritic lesions** with fluorescein stain * _dx_: dendritic ulcer or **viral cx** * _tx_: topical **ganciclovir** or **trifluride** OR PO acyclovir or valacyclovir

Answer 53

thickened lens associated with aging, smoking, DM, long-term steroid use, trauma, congenital, and children exposed to too much O2 \*\*leading cause of reversible blindness\*\* * _s/sxs_: cloudy/blurry vision, glare in vision (especially at night), halos, perception of faded color, yellowing/browning of vision * NOT PAINFUL * absent red light reflex, opaque lens * cortical spokes, or posterior subcapsular * _dx_: slit lamp exam * _tx_: surgery

Answer 54

usually result of minor local trauma, straining, sneezing, or coughing * diagnosis is clinical * tx: reassurance = should resolve within 2 weeks

Optho Flashcards

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