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216 Cards in this Set
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chemical burns
|
alkali burns are worse b/c breakdown fatty acids in membrane. (hydroxide, lime, cement, plaster, ammonia, air bag residue)
can increase IOP rinse with water/saline red eye good b/c tissue alive white eye bad, tissue dead |
|
corneal abrasion
|
need hx of trauma
epithelial defect with infiltrate AC reaction, miotic pupil |
|
seidels
|
uses to diagnose perforated cornea.
leak (positive) dark stream in fluorescein |
|
commotio retinae
|
gray white coloration in retina due to trauma. if located in macula=Berlins edema.
resolves on its own. looks like white without pressure. |
|
hyphema
|
blood in AC due to blunt trauma, sick cell, clotting disease
|
|
orbital floor fracture
|
blow out fracture breaks maxillary bone
pain, diplopia, crepitus, enophthalmos, angle recession trapped IR (limits upgaze) |
|
preseptal cellulitis
|
infection anterior to orbital septum
most common cause hordeolum |
|
orbital cellulitis
|
infection behind orbital septum
decreased vision, pain on eye movement ddx: feeling ok preseptal, sick orbital ethmoid sinusitius #1 cause can result: cavernous sinus thrombosis, brain abscess, meningitis. mucormycosis (fungal infection immunocompromised) |
|
graves ophthalmopathy
|
proptosis and upper lid retraction
females 8:1 von graefes, kotcher, SLK, restriction upgaze (due to IR/ MR swelling) biggest concern is compression ONH |
|
kochers sign
|
stare appearance due to upper lid retraction in Graves disease
|
|
von graefes sign
|
lid lag down gaze due to graves disease
|
|
carotid cavernous fistula
|
abnormal communication between artery/vein
extreme red/chemosis on involved side CN VI palsy due to increased pressure pulsatile propstosis. elevated IOP causes: head trauma rupture aneurysm |
|
cavernous hemangioma
|
most common begnign orbital tumor adults
decrease vision, diplopia, proptosis |
|
orbital tumor
|
APD, progressive proptosis, diplopia, progressive VA loss
|
|
capillary hemangioma
|
most common benign orbital tumor kids
can cause deprivation amblyopia 70% lesions gone by 7 |
|
rhabdomyosarcoma
|
most common primary pediatric orbital malignancy
rapid onset progressive proptosis bone tumor |
|
neuroblastoma
|
most common secondary pediatric orbital malignancy, poor prognosis, sudden ptosis
tumor neural crest cells that metastasized |
|
meningioma
|
most common middle aged women
primary orbital tumor or sphenoid meningioma (most common intracranial tumor to spread to orbit) |
|
dermoid cysts
|
contain sebaceous glands
associated goldenhar's syndrome: ocular dermoid, preauricular skin tags, vertebral dysplasia most common epibulbar tumor of childhood |
|
lymphoma
|
more common 50-70, proptosis
50% with orbital involvement develop systemic dz, 90% 5 year survival |
|
optic nerve glioma
|
most common 2-6, most common intrinsic tumor of ON, associated neurofibromatosis type 1.
|
|
orbital pseudotumor
|
20-50, unilateral pain, diplopia, proptosis, increase IOP, reduced corneal sensation
idiopathic inflammatory process bilateral: think wegners, polyarteritis nodosa, lymphoma |
|
tolosa hunt syndrome
|
idiopathic inflammation of cavernous sinus
pain, diplopia remember 3,4,6, V1, V2 pass through V3, V7 dont |
|
ocular rosacea
|
females, norther european ancestr
telangiectasia, rhinophyma, facial flushing. triggers |
|
contact dermatitis
|
type 4. recent change make up.
|
|
ocular cicatricial pemphigoid
|
symblepharon, ankyloblepharon
systemic mucous membrane disoreder |
|
dermatochalasis
|
common condition in elderly
weakened orbital septum, fat pushes through |
|
chalazion
|
hard nodule without pain, redness
inflammation meibomian gland. hx acne rosacea. |
|
hordeolum
|
pain, redness, caused by staph infection of meibomian gland (internal) zeis/moll (external=stye)
|
|
ectropion
|
age related most common cause
paralytic due to CN VII palsy (affects riolans muscle) |
|
entropian
|
age related most common
ulceration worst case scenario |
|
floppy eyelid syndrome
|
obese men with sleep apnea
chronic red eyes in morning chronic papillary conjunctivitis spontaneous lid eversion during sleep |
|
benign essential blepharospasm
|
involuntary bilateral twitching
orbicularis oculi, procerus, corrugator muscles. idioopathic most common |
|
myokymia
|
unilateral twitching eye lid of orbicularis oculi
|
|
meiges syndrome
|
blepharospasm + lower facial abnormalities
|
|
sebaceous gland carcinoma
|
rare. elderly females
if get recurrent chalazion think about this. yellow and hard (chalazion flesh colored) arises from meibomian glands, 60% risk death |
|
ketatoacanthoma
|
tumor eyelid due to UV.
grows quickly and spontaneous resolves. |
|
canaliculitis
|
smoldering unilateral red eye. swollen puncta (pouting puncta), discharge with palpation, actinomyces most common cause.
|
|
dacryoadenitis
|
lacrimal gland inflammation
acute: bacterial infection chronic (more common): sarcoid s shaped ptosis |
|
Jones I test
|
evaluate ability tears to pass through lacrimal drainage
fluorescein instilled, wait 5 min look for in patients throat or blow their nose. positive = patent (normal) negative-->jones II |
|
Jones II
|
use saline to irrigate nasolacrimal drainage
if it comes out punctum same side -->canalicular blockage comes out punctum other eye-->nasolacrimal blockage positive= patent pt tastes saline negative= pt doesn't taste saline, still blocked. |
|
primary acquired melanosis
|
elderly white pts. unilateral
30% progress to malignant melanoma acquired melanoma on conj |
|
conjunctival melanoma
|
arises from PAM
pigmented or non pigmented thickness of lesion is big indicator to progression to melanoma (increase melanocytes) metastasize more commonly SCC |
|
conjunctival intraepithelial neoplasia
|
rare premalignant condition non pigmented lesion on conj with neo (leads to squamous cell carcinoma)
|
|
conjunctival squamous cell carcinoma
|
malignant tumor on conj arises from conjunctival intraepithelial neoplasia (CIN)
|
|
most common cause discharge
|
bleph
|
|
bacterial conjunctivitis
|
rare, redness, discharge
kids: H. influenzae adults: staph aureus, staph epidermidis |
|
gonococcal conjunctivitis
|
hyperacute redness.
purulent discharge, pseudomembranes, marked preauricular lymphadenopathy due to neisseria gonorrhea can invade intact cornea |
|
adenoviral conjunctivitis
|
most common virus that affects eye
more common adults than kids follicular conj, injection, preauricular adenopathy, pseudomembrane, SEI (indicate no longer contagious) result from UTI |
|
epidemic keratoconjunctivitis
|
viral conj due to adenovirus 8 and 19
see in adults, corneal involvement (SEI's 80%) |
|
pharyngoconjunctival fever
|
viral conjunctivitis due to adenovirus 3,7
triad: acute follicular conjunctivitis, mild fever, pharyngitis more commonly affects children swimming pool |
|
molluscum contagiosum
|
dome shaped waxy nodules
due to poor hygiene caused pox virus, multiple think HIV |
|
seasonal allergic conjunctivitis
|
itchy, type 1 hypersensitivity
|
|
papillae
|
inflamed, central vessel
non-specific see with bacterial, allergic conj |
|
follicles
|
avascular, white/grey, nodules
follicles: chlamydia, toxic, viral |
|
vernal keratoconunctivitis (VKC)
|
male children. seasonal.
bilateral papillae, limbus (trantas dots), upper palpebral conj (cobblestone), corneal involvement (shield ulcer) |
|
atopic keratoconjunctivitis
|
most common young adults with hx atopic dermatitis
itchy eyes. dennies lines (folds skin from rubbing eyes) papillae inferior, small |
|
giant papillary conjunctivitis
|
itchy eyes, large papillae
decreased CL wearing time. more common with silicone hydrogel |
|
chlamydia trachoma
|
leading cause of preventable blindness 3rd world.
spread housefly. chronic conjunctvitis (A-C) Arlt lines: white scarring superior tarsal conjunctiva Herberts pits: depression limbal conjunctiva corneal ulcer |
|
superior limbic keratoconjunctivitis
|
most common middle age females
bilateral superior conj redness "velvety appearance" associated thyroid eye disease, poor cl fit |
|
phyctenulosis
|
white lymphocytic nodule with dilated vessels surrounding.
delayed hypersensitivity rxn (type 4) due to bleph, TB, acne rosacea |
|
parinauds oculoglandular syndrome
|
red eye unilateral granulomatous palpebral conjunctivitis, preauricular/submandibular lymphadenopathy
due to: cat scratch fever |
|
pediculosis
|
blood tinged debris on lids/lashes, preauricular lymphadenopathy, chronic conjunctivitis, itchy
caused by phthirus pubis ddx demodicosis (from mites, sleeving eyelash, asymptomatic) |
|
subconjunctival heme
|
redness conjunctiva
ask strain, bleeding disorder, medications (aspirin, coumadin), HTN order PT/PTT if recurs |
|
episcleritis
|
common. young adults
acute unilateral painless red eye. sectoral (70%), simple or nodular (can be moved), tx: steroid ddx: phenyl (constricts episcleral vessels) |
|
scleritis
|
rare. female.
red painful eye anterior most common. nodular or necrotizing with or w/o inflammation. necrotizing with is worst, 25% pts die. necrotizing w/o is usually result RA. |
|
most common type anterior uveitis
|
unilateral, acute, anterior, non granulomatous
|
|
anterior uveitis
|
pain, redness, photophobia (acute)
asymptomatic (chronic). most commonly idiopathic diagnosed: cells AC decreased IOP affected eye, PAS, PS, cataract, KP due to breakdown blood aqueous barrier |
|
signs chronic anterior uveitis
|
koeppe nodules, mutton fat KPs, busacca nodules
|
|
acute non-granulomatous uveitis causes
|
AK, Reiters, IBD, Behcets, lyme, glaucomatocyclitic crisis
|
|
chronic granulomatous uveitis causes
|
TB, sarcoid, HSV, HZO (increased IOP), syphilis
|
|
chronic non-granulomatous uveitis
|
JRA, fuchs heterochromic iridocyclitis
|
|
meds that cause uveitis
|
rifabutin, systemic sulfonamaides, cidofovir
|
|
posterior uveitis
|
floaters, decreased vision, WBCs vitreous, break down blood aqueous barrier
|
|
causes posterior uveitis
|
toxoplasmosis (most common), histoplasmosis, sarcoidosis, syphilis, pars planitis (young pts), CMV
|
|
exposure keratopathy
|
dryness cornea due to exposure
SPK to ulceration cause: bell's, thyroid decreased corneal sensitivity |
|
filamentary keratopathy
|
history of dry eye
filament=epithelial cells + mucous |
|
dry eye
|
more common with aging.
two types: evaporative (lipid problem), keratoconjunctivitis burning, itching, worse at end of day, red (most common cause) |
|
meds cause dry eye
|
antihistamines, b-blockers, estrogen therapy, oral contraceptives
|
|
evaporative dry eye causes
|
deficient lipid secretions of meibomian glands, zeis glands, eyelid related problems (decreased blind)
|
|
keratoconjunctivitis sicca
|
due to aqueous tear deficiency
|
|
test dry eye
|
schirmer test (5 min, unanesthetized >15mm reflex, basal. anesthetized >10 basal)
phenol red: >10 TBUT: >10 |
|
vogts striae
|
stromal vertical stress lines associated with keratoconus
|
|
corneal hydrops
|
ruptured descemets membrane associated with keratoconus (worst case scenario)
|
|
rizzutis sign
|
conical reflection on the nasal cornea when light is shown from temporal side
associated keratoconus |
|
keratoconus
|
non-inflammatory condition starts with bowman damage. most commonly begins around pubert
mild <48D moderate: 48-54 D severe: >54D |
|
keratoconus associated with
|
VKC, AKC, turner, down, osteogenesis, marfans, mitral valve prolapse, ehlers danlos.
T-DOMME |
|
fleischers ring
|
iron deposits cornea base of cone due to keratconus
|
|
hudson stahli lines
|
middle to lower cornea appear in elderly
|
|
stockers line
|
leading edge pterygium
|
|
ferry line
|
leading edge filtering bleb
|
|
kayser fleischer ring
|
copper accumulation edge cornea due to wilsons disease
|
|
pellucid marginal degeneration
|
corneal thinning early adulthood.
kissing doves topography. thinnest area inf crescent cone |
|
keratoglobus
|
congenital AR diffuse corneal thinning.
complication: descemet membrane rupture associated: ehlers danlos, blue sclera, lebers congenital amaurosis |
|
ABMD
|
most common anterior corneal dystrophy AD.
90% will not develop corneal erosions map lines, dots, fingerprints corneal epithelium |
|
meesmans
|
AD, asymptomatic, multitude epithelial cysts.
|
|
reis buckler dystrophy
|
AD, RCE, abnormal development collagen bowmans.
|
|
macular dystrophy
|
stromal corneal dystrophy AR.
mucopolysaccharide deposits and cloudy cornea |
|
granular dystrophy
|
AD, most common stromal dystrophy.
hyaline deposits. RCE deposits rare |
|
lattice dystrophy
|
AD. stromal
amyloid deposits. RCE |
|
schnyders dystrophy
|
AD. current/past high cholesterol
stromal cholesterol deposits. ask high cholesterol associated xanthelesma |
|
kayser fleischer ring
|
copper accumulation edge cornea due to wilsons disease
|
|
pellucid marginal degeneration
|
corneal thinning early adulthood.
kissing doves topography. thinnest area inf crescent cone |
|
keratoglobus
|
congenital AR diffuse corneal thinning.
complication: descemet membrane rupture associated: ehlers danlos, blue sclera, lebers congenital amaurosis |
|
ABMD
|
most common anterior corneal dystrophy AD.
90% will not develop corneal erosions map lines, dots, fingerprints corneal epithelium |
|
meesmans
|
AD, asymptomatic, multitude epithelial cysts.
|
|
reis buckler dystrophy
|
AD, RCE, abnormal development collagen bowmans.
|
|
macular dystrophy
|
stromal corneal dystrophy AR.
mucopolysaccharide deposits and cloudy cornea |
|
granular dystrophy
|
AD, most common stromal dystrophy.
hyaline deposits. RCE deposits rare |
|
lattice dystrophy
|
AD. stromal
amyloid deposits. RCE |
|
schnyders dystrophy
|
AD. current/past high cholesterol
stromal cholesterol deposits. ask high cholesterol associated xanthelesma |
|
fuchs endothelial dystrophy
|
AD. females 50-60.
blurred vision worse in morning endothelial guttata, increased polymegathism, polypleomorphism thick pachymetry bullae and scarring late sign due to decreased ability endo pumps less than 500 cells/mm2 leads to corneal edema, 2000 expected at 70. |
|
hassel henle
|
guttata due to increased thickness descemets in periphery
|
|
posterior polymorphous dystrophy
|
AD, early in life. innocuous usually. endothelial prob.
corneal edema and bullae can occur. 15% glaucoma |
|
megalocornea
|
x linked, high myopia. astigmatism.
>13mm horz diameter associated: ehlors, marfans, osteogenesis risk glaucoma, lens subluxation |
|
microcornea
|
AD or AR.
horz diameter <10mm hyperopic risk glaucoma |
|
cornea plana
|
rare, AD or AR
flat cornea <38 D. |
|
sclerocornea
|
rare, bilateral vascularization of peripheral cornea.
80% associated cornea plana |
|
haab's striae
|
horz cracks in descemets membrane due to increased IOP from congenital glaucoma
|
|
posterior embryotoxin
|
anterior schwalbes line. normal variant.
small percent get glaucoma |
|
axenfelds anomaly/syndrome
|
posterior embryotoxin + iris strands
50-60% develop glaucoma (syndrome if develop glaucoma) |
|
riegers anomaly
|
posterior embryotoxin, iris strands, displaced pupil and iris atrophy
50-60% develop glaucoma syndrome: mental retardation, dental, facial, skeletal abnormalities |
|
peter's anomaly
|
central corneal opacity with iris adhesions
50% develop secondary glaucoma |
|
aniridia
|
rare bilateral AD
partial-complete loss iris glaucoma 75%, foveal hypoplasia, disc hypoplasia |
|
bacterial keratitis
|
most common cause corneal ulcer
red eye, pain, photophobia, decreased VA ulcer=infiltrate+epithelial defect cause: pseudomonas (can perforate), staph epi, staph aura, haemophilus influenzae, moraxella cl wear, esp extended wear |
|
bacteria that can invade intact cornea
|
Canadian National Hockey League
Corneybacterium diphtheriae, neisseria gonorrhea, haemophilus, listeria |
|
fungal keratitis
|
cause: filamentous (aspergillus, fusarium), non filamentous (candida, immunocompromised)
hx: vegetative trauma, steroid use pain, photophobia feathery edges with surrounding satellite lesions culture: sabourauds |
|
acanthamoeba keratitis
|
parasitic infection
associated with inadequate cl hygiene, hot tub use pain is severe and out of proportion to signs stromal infiltrates or defects that appear pseudodentritic ring ulcer (late finding) culture heat killed E. coli agar |
|
HSV
|
DNA virus, young pts.
hides CN V comes out wit stress, old, HIV, immunocompromised epithelial keratitis: dendritic ulcer edges stain RB disciform keratitis: stromal IK: dense stromal edema blepharoconjunctivitis: vesicles/crusting, follicles, preauricular lymphadenopathy |
|
leading causes blindness US
|
#1 corneal trauma
#2 stromal scarring due to HSV |
|
herpes zoster virus
|
affects elderly. if less than 40 suspect HIV.
prodrome, post herpetic neuralgia hutchinsons sign: pustules side of nose skin lesions respect dermatomes, upper eyelid only, conjunctivitis, episcleritis pseudodendrites: no terminal endbulbs, entire lesion stains RB, fluorescein doesn't stain |
|
hutchinsons triad
|
IK, teeth deformities, deafness
seen with congenital syphilis |
|
moorens ulcer
|
forms: unilateral older pt (most common). young, bilateral, aggressive, nigerian males
peripheral gray infiltrate stromal, followed by epithelial defect 360. idiopathic. associate hep C |
|
infiltrate
|
immune mediated response. not a sign of infection
|
|
terriens marginal degeneration
|
corneal degeneration. rare. men over 40.
asymptomatic, ATR, decreased acuity. bilateral. thinning starts superior. associated vascular pannus. idiopathic |
|
salzmanns nodular degeneration
|
females
smooth elevated blue-gray stromal opacities results from: chronic keratitis (trachoma, phylectenulosis, dry eye, IK) |
|
limbal girdle vogt
|
age related corneal degeneration
asymptomatic bilateral opacities 3 and 9 o'clock. no clear zone between it and limbus |
|
band keratopathy
|
due to gout/hypercalcemia
calcium deposits bowmans at 3 an 9 oclock. |
|
corneal arcus
|
most common peripheral corneal opacity
bilateral lipid deposition bowmans, descemets clear zone separation btw it and limbus if present under 40 lipid profile warranted |
|
crocodile shagreen
|
stromal opacities bowmans.
corneal degeneration |
|
corneal farinata
|
AD or senile change.
corneal degeneration flour dust deposits deep stroma central |
|
graft rejection
|
type 4. 30% pts will have in 1 year
khodadoust line: endothelial rejection line krachmers spots: SEI, stromal rejection |
|
absolute contraindications refractive surgery
|
<21, refractive instability, keratoconus, CL warpage, immunosuppression, active HSV, CT, unrealistic expectations
|
|
complications all refractive surgery
|
dry eye, halos, glare, starbursts, irregular astigmatism, endophthalmitis
|
|
LASIK complications
|
ecstasia, flap wrinkles, DLK, disturbed tear function
|
|
LASIK
|
laser in situ keratomileusis
excimer laser to midstroma |
|
complications PRK
|
regression, steroid induced glaucoma, corneal haze
|
|
PRK
|
photorefractive keratectomy
remove epithelium with chemicals and apply laser to bowmans |
|
complications radial keratotomy
|
hyperopic shift, perforation, diurnal fluctuation
|
|
posterior subcapsular cataracts
|
in front of posterior lens capsule
affect near vision more due to x-ray, steroids |
|
presenile cataracts
|
associated DM, myotonic dystrophy, wilsons disease, hypocalcemia, atopic dermatitis
|
|
vossius ring
|
iris pigment on anterior lens capsule
|
|
toxic cataracts
|
anterior subcapsular
chlorpromazine, amiodarone, miotics, gold salts |
|
secondary cataracts
|
anterior uveitis (most common), high myopia, RP, gyrate atrophy
|
|
lens subluxation
|
most common due to trauma
marfans, ehlers danlos, homocystinuria |
|
striate keratopathy
|
corneal edema/ folds descemets membrane post cataract surgery
|
|
meds to be concerned with cataract surgery
|
anticoagulants, tamsulin
|
|
elschnig pearls
|
type of posterior capsular opacification
most often seen in children who undergo cataract surgery |
|
irvine gass syndrome
|
CME after cataract surgery
most common reasons decrease VA after cataract surgery |
|
asteroid hyalosis
|
calcium phosphate in normal vitreous
associated with aging no visual consequences |
|
synchysis scintillans
|
rare. golden brown cholesterol crystals in vitreous.
occurs after chronic uveitis, vitreous hemorrhage or trauma |
|
PVD
|
prevalence approximates age (ie 50, 50%)
floaters, flashes of light weiss ring (detached ONH) |
|
vitreous hemorrhage
|
most common cause diabetes.
occurs when vitreous pulls on neo and vitreous face isn't intact |
|
pre-retinal hemorrhage
|
between vitreous and retina
hemorrhage due to neo (diabetes) |
|
CRVO
|
HTN, DM.
unilateral painless VA loss. hemorrhages all 4 quadrants due to obstruction CRV due to thrombus. complications: macular disease, neo (major concern 90 glaucoma) ischemic: 10 DD capillary nonperfusion FA and VA <20/200 nonischemic usually recover to 20/40 |
|
BRVO
|
HTN, DM.
more common than CRVO. most common retinal vascular occlusive disease. asymptomatic or unilateral VA loss. complications: neo, macular 1 quadrant hemes, sup temp most common due to thrombus |
|
CRAO
|
HTN, DM, carotid occlusive disease, cardiac valve disease
more common than BRAO's. if young ask IV or birth control VA loss 20/400 or worse APD, cherry red spot if cilioretinal artery. whitening all 4 quadrants due to emboli. possibly GCA. neo glaucoma rare. |
|
BRAO
|
HTN, DM, carotid occlusive disease, cardiac valve disease.
asymptomatic or unilateral VA loss white 1 quadrant, permanent VF loss. most commonly results from cholesterol plaque (hollenhorst plaque) |
|
diabetic retinopathy
|
leading cause of new blindness in US
due to damage to blood retinal barrier as pericytes are lost most important risk factor is duration of insulin dependent diabetes |
|
two threats to vision DR
|
Macular (edema, ischemia most common reason for legal blindness)
PDR (vitreous heme, tractional RD, neo glaucoma) |
|
high risk characteristics of proliferative DR
|
neo greater than 1/4 DD
any NVD or NVE with vitreous/ pre retinal heme |
|
CSME
|
retinal thickening within 500 microns (1/3 DD) of foveal center
HE within 500 microns of foveal center with adj thickening retinal thickening 1DD within 1 DD foveal center |
|
HTN retinopathy
|
stage 3: flame shaped hemorrhage, CWS, HE
stage 4: papilledema, macular star |
|
elschnig spots
|
choroidal infarcts apparent in severe HTN retinopathy
|
|
Ocular ischemic syndrome
|
more common men 50-80.
gradual VA loss, periorbital pain, amaurosis fugax unilateral dot/blot hemes midperipheral, dilated non tortuous veins, neo disc and iris due to carotid atherosclerosis, GCA |
|
idiopathic juxtafoveolar retinal telangiectasia
|
three types: unilateral congenital (men 40s moderate VA loss), unilateral idiopathic form (mild VA loss), bilateral acquired form (poor prognosis)
right angle venules and varying degrees exudate near fovea abnormal perifoveal capillaries |
|
coats disease
|
males less than 20.
decreased unilater VA, strabismus, leukocoria unilateral telangiectatic vessesls with light bulb appearance, hard exudates |
|
ROP
|
infants born less than 36 weeks or that weighs 2,000 g or less and has received oxygen therapy
leukocoria and strabismus anterior temporal last region to develop proliferative retinopathy |
|
ARMD
|
most common pts >50. exudative ARMD chief cause VA loss pt >50.
dry AMD-asymptomatic wet AMD-rapid onset vision loss RPE abnormalities, geographic atrophy wet AMD-drusen with neo membrane 12% dry severe vision loss wet AMD- subretinal hemorrhage, sub-RPE hemorrhage, subretinal detachment (serous RD), sub-RPE detachment (PED) |
|
risk factors increase risk progression from dry to wet ARMD
|
multiple soft drusen, focal hyperpigmentation, HTN, smoking
|
|
categories AMD
|
1: few or small drusen
2: several small drusen or a few medium sized drusen 3: several medium size drusen, 1 or more large drusen 4: GA or wet AMD |
|
central serous choroidopathy
|
men type A 20-50
sudden onset blurred vision, metamorphopsia localized serous macular detachment smokestack appearance FA sympathetic nervous system hyperactivity |
|
histoplasmosis
|
most common ohio-mississippi river valley
asymptomatic triad: peripapillary atrophy, multifocal lesion periphery, maculpathy (CNV) fungal infection |
|
high myopia
|
>6D or axial length 26 mm
decreased VA posterior staphylomas, fuchs spots, lacquer cracks (break bruchs), macular holes, cataracts |
|
fuchs spots
|
hyperpigmented spots in macula from RPE hyperplasia
|
|
epiretinal membrane
|
more common females. glistening membrane (cellophane), advanced--macular pucker.
break ILM with glial proliferation due to PVD, retinal breaks |
|
macular holes
|
aging women
decreased VA. stages: 1: impending-loss foveal depression with yellow spot/ring. 2: round with pseudo operculum. 3: large full thickness with operculum. 4: stage 3 + PVD idiopathic |
|
watzke allen sign
|
slit lamp light appears broken to pt
|
|
CME
|
intraocular surgery, previous uveitis
decreased VA. loss foveal reflex, foveal thickening |
|
macular photostress test
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determine BCVA, hold bright light 2cm from pts eye, pt look at light 10 sec, measure time to til patient can read one line less than BCVA.
should be less than 60 sec. |
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RP
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AD, also non inherited
most common retinal dystrophy associated with Ushers (hearing loss) night blindness, peripheral VA loss triad: bone spicule pigmentation, arteriolar attenuation, waxy optic disc pallor due to loss RPE and photoreceptor function |
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stargardts
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6-20 onset. AR. most common hereditary macular dystrophy.
rapid VA loss, color vision abnormalities pisciform flecks, beaten bronze macular pattern |
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choroideremia
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x linked recessive, onset 1st decade
night blindness, peripheral VA loss. progressive bilateral diffuse atrophy of RPE and choriocapillaris. macular spared until late stages. |
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cone dystrophy
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1st-3rd decade. AD.
decreased central VA, severe photophobia, severe color VA loss normal fundus, abnormal ERG VA: 20/400 |
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ddx bull's eye maculopathy
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stargardts, progressive cone dystrophy, chloroquine and hydroxycholorquine and thioridazine toxicity
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best's disease (vitelliform dystrophy)
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AD, 5-10.
decreased VA or asymptomatic bilateral, yellow, round, subfoveal, egg yolk lesion, may have CNV, atrophy. decreased EOG, normal ERG |
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adult foveomacular vitelliform dystrophy
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patients 30-50. like best's with better prognosis. normal EOG and ERG
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gyrate atrophy
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AR.
nightblindness, decreased VA, constricted VF. macula spared until 4th-7th decade, high myopia and astigmatism. due to ornithine aminotransferase deficiency |
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RD
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males, over 45, most commonly in myopes with or without trauma.
vitreous floaters, curtain over vision, Va loss. undulating retina schafers sign=pigment anterior vitreous. pigment line present with chronic. associated lattice degeneration. |
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non rhegmatogenous RD
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RD due to traction (PDR) or serous (ARMD)
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age related degenerative retinoschis
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more common over 40.
asymptomatic most common inferiotemporal, retinal is immobile, absolute VF defect. hyperopic pts. splitting OPL |
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angioid streaks
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pseudoxanthoma elasticum most common cause of systemic causes. idiopathic 50%.
asymptomatic or VA loss from CNV. PEPSI. break Bruchs. |
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ocular HTN
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>21 on two or more visits with open angle and without optic neuropathy.
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risk factor for POAG
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IOP (only one we can control), race (AA), family history, age, thin corneas
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sturge weber
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ipsilateral glaucoma
vascular birth mark. |
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POAG
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optic nerve damage with IOP >21.
asymptomatic until later in disease, then peripheral VA loss. most important sign: ONH change. VF: nasal steps most common |
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pseudoexfoliation
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age related with caucasians.
most common identifiable cause of elevated IOP and glaucoma. see sampaolesi's line. unilateral. |
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pigment dispersion syndrome
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bilateral, more common young caucasians. 50% develop glaucoma.
asymptomatic, halos after exercise or dilation. more common myopes and males. kruckenbergs spindle |
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normal tension glaucoma
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type of POAG with IOP <21. diurnal IOP important to make sure not POAG. open angle.
drance hemorrhage more common. females greater risk, esp japanese. VF defects: more focal and dense. inferotemporal rim most often affected. |
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primary angle closure glaucoma
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highest risk after coming down from full dilation.
two causes: pupillary block, plateau iris syndrome (less common) ocular pain, headaches, halos, progressive VA loss. hazy cornea, mid dilated pupil with poor response to light, glaucomflecken, occluded angle gonio, IOP 50-100. greatest threat to vision is CRAO. sub acute most common. |
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secondary angle closure glaucoma
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neo and uveitis
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neovascular glaucoma
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severe VA loss. CRVO most common cause then DR. examine pupillary margin.
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uveitic glaucoma
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due to PAS and PS. sticky iris due to inflammation.
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inflammatory glaucoma
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glaucomatocyclitic crisis and fuchs heterochromic iridocyclitis
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glaucomatocyclitic crisis
aka posner schlossman |
acute trabeculitis.
IOP 40-60 with open angle. mild anterior chamber rxn |
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fuchs heterochromic iridocyclitis
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chronic non granulomatous anterior uveitis
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