Adult Med

Front 1

What is the most common cause of orbital cellulitis?

Back 1

(usually staph aureus, other bacteria, virus , or fungi possible)
Paranasal sinusitis;which leads to the secondary infection throughout the lid tissue & sometimes involving the orbit.

Front 2

Orbital cellulitis S/Sx;

Back 2

Extreme orbital pain, Eyelid redness & swelling, Conjunctival hyperemia & edema, Exopthalmos (bulging eyes), Impaired mobility of the eye, fever & malaise.

Front 3

What is hyperemia?

Back 3

Congestion; an unusual amount of blood in a part.

Front 4

Orbital cellulitis Dx?

Back 4

Find primary site of infection;
Examine; skin, nasopharynx, teeth, & oral cavity
X-ray/CT of sinuses
Culture any discharge

Front 5

Orbital cellulitis Tx;

Back 5

Mild cases; Cephalexin 500mg q 6h x 14days
Severe cases (usually); Cefazolin 1g IV q 6f X 7days
I&D if no response to ABX
Change ABX as indicated by C&S

Front 6

What six bones make up the orbit?

Back 6

Frontal, Ethoidal, Lacrimal, Sphenoid bones, Maxilla, Zygoma.

Front 7

What is a orbital FX?

Back 7

A break in the orbit portion of 1 or more of the 6 orbital bones.

Front 8

Orbital cellulitis complications;

Back 8

Loss of vision from optic neuritis.
Thrombophlebitis of the orbital veins resulting in;
Cavernous sinus thrombosis
Panophthalmitis
Spread of the infection to the meninges & brain

Front 9

Blow out fx pathophysiology;

Back 9

Usually in the orbital floor occurs as a result of hydraulic forces generated by the compressed liquid of the eye & direct buckling of the inferior floor.

Front 10

Orbital Fx S/Sx;

Back 10

Nerve Anesthesia, hx of blunt ocular trauma, pain, local tenerness, double vision, intense pressure or swelling of the eye, epitaxis, extraocular muscle entrapment, intramuscular or infraorbital hemorrhage, nerve damage, orbital emphysema (caused by communication w/adjoining sinuses.

Front 11

In floor fx what can happen to the eye?

Back 11

It can partially drop down into the maxillary sinus causing enophthalmos (recession of the globe) & intrapment of the inferior rectus or inferior oblique muscle.

Front 12

What does intrapment lead to?

Back 12

Limited down-gaze, no up-gaze.
Prolonged entrapment leads to fibrosis of the muscle, irreversible scarring, & permanent motility impairment.

Front 13

What can be damaged w/medial wall fx?

Back 13

The medial rectus &/or the lacrimal apparatus.

Front 14

What is the greatest risk to consider w/medial wall fx?

Back 14

Orbital cellulitis

Front 15

What are the critical S/Sx of a recent blow out fx?

Back 15

Edema & echymosis of lid tissues, restriction of ocular motility (especially vertical), obital crepitus, hypoesthesial of the ipsilateral cheek (due to entrapment of the infraorbital nerve)

Front 16

What are the types of orbital fx?

Back 16

Le Fort I-tooth bearing portion separated from upper maxilla.
Le Fort II-across orbital floor & nasal bridge.
Le Fort III-across frontozygomatic sutureline, entire orbit & nasal bridge.

Front 17

What are the S/Sx for a pt that initally ignored tx for a orbital fx?

Back 17

(Inflammatory manifestations of trauma have subsided)
relative enophthalmos, motility restriction (usually up-gaze), infraorbital hypoesthesia.

Front 18

What is enophthalmos?

Back 18

Recession of the eyeball into the orbit. Opposite of exophthalmos.

Front 19

What is hypoesthesia?

Back 19

A dulled sensitivity to touch.

Front 20

Orbital fx diagnostic tests?

Back 20

Ct is the procedure of choice.
(Better imaging of the bony structures than X-Ray or MRI)
Obtain both axial & coronal scans.

Front 21

What orbital fx should be considered for surgical intervention?

Back 21

Floor fx w/assiociated herniation of the orbital contents.
Generally surg is only for pts w/recent trauma w/diplopia in primary gaze or downgaz or cosmetically unacceptable enophthalmos. Specialists wait 10-14 days to allow resolution of edema & hemorrhage.

Front 22

Is surgical repair necessary in a medial wall fx?

Back 22

Not if it is a uncomplicated ethmoid fx, the condition will resolve spontaneously in 3-4 weeks.

Front 23

What is a hordeolum?

Back 23

Stye, a pimple at the lid magin, resulting from infection of small glands in the lid margin.

Front 24

Hordeolum (stye) External S/Sx;

Back 24

Pain, Diffuse redness, tenderness of lid margin, Small round tender area, photophobia, feeling that something is in the eye, yellow spot (abcess)that may rupture & relieve pressure & pain.

Front 25

Hordeolum (stye) Internal S/Sx;

Back 25

Rare
Deeper
Can be seen through the conjunctive

Front 26

Hordeolum (stye) tx;

Back 26

Usually self limiting, (topical ABX is ineffective), (oral ABX are selsom recommended), Warm moist compress, I&D will expedite healing.

Front 27

What is a Chalazion?

Back 27

Chronic granulomatous enlargement of the melbomian gland from occlusion of its ducts often following inflammation of the gland & surrounding tissue.

Front 28

Chalazion S/Sx?

Back 28

Early it looks like a stye.
Lid edema
Irritation
Later: Painless
Slowly growing round mass in lid
Red or gray mass

Front 29

Chalazion D/Dx;

Back 29

If in lower lid near inner canthus, chroic dacryocysitis must be ruled out.

Front 30

Chalazion tx;

Back 30

Resolve after a few months.
Hot compress TID-QID may help.
incession & curettage or corticosteroid administration if no resolution after 6 wks.

Front 31

What is Blepharitis?

Back 31

Inflammation of the lid margins w/redness, thickening & often the formation of scales & crusts or shallow marginal ulcers.

Front 32

Blepharitis Etiology;

Back 32

Acute bacterial infection (staph) of the lid margin.
Involves lash follicles & meibomian glands.
Chronic Seborrheic Blepharitis, asso. w/seborrheic dermatitis.

Front 33

Blepharitis S/Sx;

Back 33

Itch, burn, redness & edema of the lid, Loss of lashes, Conjunctival irritation w/lacrimation, photophobia, pustules, shallow ulcers, crusts, eyes glued together in the AM.

Front 34

Seborrheic type of Blepharitis S/Sx;

Back 34

Greasy scales
Easily removable
Plugged meibomian gland

Front 35

Ulcerative type Blepharitis Tx;

Back 35

Staph infection
ABX ointment (bacitracin/polymyxin B or gentamycin)

Front 36

Seborrheic type Blepharitis Tx;

Back 36

Improve eyelid hygiene
Scrub lid w/coton swab dipped in baby shampoo.
Tx other areas of face prn.
Warm compresses unplug meibomian glands.

Front 37

What is dacrocystitis?

Back 37

Infection of the lacrimal sac.
(usually secondary to dacryostenosis)

Front 38

What is dacryostenosis?

Back 38

Obstruction or narrowing of a lacrimal or nasal duct.

Front 39

What are the S/Sx of acute dacrocystitis?

Back 39

Pain, redness & swelling over the inner aspect of the lower eyelid, Epiphoria, Fever & severe erythematous swelling around the nasal aspect of the lower lid, Lacrimal sac mucopurulent d/c can be expressed from the inferior punctum, (pts w/poor hygiene are at greater risk)

Front 40

What is Epiphoria?

Back 40

Abnormal overflow of tears from overproduction or blocked lacrimal duct.

Front 41

What are the S/Sx of chronic dacrocystitis?

Back 41

Slight swelling of the sac, Pus, Lacrimal sac may become distended, abcess & fistula.

Front 42

Acute dacrocystitis Tx;

Back 42

(Mild) Hot compresses, Cephalexin 500mg QID po
(Severe) I&D
Cefazolin 500mg QID IV.

Front 43

Chronic dacrocystitis Tx;

Back 43

(stenosis may be causing problem)
Dilating nasolacrimal duct w/probe.
Nasolacrimal intubation.
Surgery

Front 44

What is Sjogern's Syndrome?

Back 44

Chronic systemic inflammatory disorder of unkown cause, characterized by dryness of the mouth, eyes & other muccous membranes. Associated w/rheumatic disorders (SLE, RA).

Front 45

Is Sjogern's Syndrome always an isolated phenomenon?

Back 45

Not always it is sometimes associated w/SLE or RA & there is an increased risk on non-Hodgkin's lymphoma. (Lymphocytic infiltration)

Front 46

How do you diagnose Sjogern's Syndrome?

Back 46

Serology & salivary gland biopsy.

Front 47

Sjogern's Syndrome Tx;

Back 47

Artificial tears & ointments.
Lifestyle modifications, Humidifiers, Tx any related infections (Blepharitis) w/warm compresses etc.
Occlusion of the nasolacrimal punctum.

Front 48

What is Keratoconjunctivitis Sicca?

Back 48

Chronic, bilateral desiccation of the conjunctiva & cornea due to inadequate tear volume or excessive loss of tears due to accelerated evaporation.

Front 49

What is desiccation.

Back 49

The process of drying up.

Front 50

What are the S/Sx of Keratoconjunctivitis Sicca?

Back 50

Itch, Burning, Photophobia, Gritty sensation, Pressure behind the eye, Foreign body sensation.

Front 51

When do the S/Sx of Keratoconjunctivitis Sicca worsen?

Back 51

Reading, working, driving, watching TV, dusty, smoky areas, dry envoronments.

Front 52

Keratoconjunctivitis Sicca Dx;

Back 52

Scattered fine punctate loss of the corneal or conjunctival epithelium, Stain w/fluorescein, Conjunctive appear dry w/folds in some cases, Schirmer test.

Front 53

Keratoconjunctivitis Sicca Tx;

Back 53

Artificial tears & ointments.
Lifestyle modifications, Humidifiers, Tx any related infections (Blepharitis) w/warm compresses etc.
Occlusion of the nasolacrimal punctum.

Front 54

What is ptosis?

Back 54

A drooping of the upper or lower eyelid.

Front 55

What are causes of ptosis?

Back 55

Stroke, Myasthenia gravis (neuromuscular issue), damage to the oculomotor nerves, damage to the sympathetic nerve supply (Hormer's syndrome), Weakened muscle, relaxed tissues, weight of hemiated fat, congenital.

Front 56

What is Myasthenia Gravis?

Back 56

Neurological dz that results in bilateral ptosis worsening as the day progresses.

Front 57

What is Horners Syndrome?

Back 57

Nerve pathway between hypothalmus & eye interrupted causing unilateral ptosis, anhidrosis & pupillary miosis.

Front 58

What is Entropion?

What causes Entropion?

Back 58

Inversion of the eyelid.

Aging or scar formation.

Front 59

What are S/Sx of Entropion?

Back 59

Causes irritation as lashes rub against cornea.
Ulcers & scarring.

Front 60

What is Ectropion?

What causes Ectropion?

Back 60

Eversion of the eye lid.

Aging or scar formation.
Usually from the tissue relaxing w/aging.

Front 61

What are the S/Sx of Ectropion?

Back 61

Poor drainage of tears
Redness
Irritation
Epiphora

Front 62

What is Epiphora?

Back 62

An abnormal overflow of tears down the cheek due to excess secretion of tears or obstruction of the lacrimal duct.

Front 63

Entropion & Ectropion Tx;

Back 63

Surgery
Artificial Tears

Front 64

What is Coloboma?

Back 64

Congenital cleft in some part of the eye. (commonly in the iris, but may also occur in the lid(s) or pigment epithelium & chroid).

Front 65

What is the cause of Coloboma?

Back 65

Faulty closure during prenatal developmen; usually hereditary (secondary complication; cataracts).

Front 66

What are conditions associated with Coloboma?

Back 66

Microphthalmia, polydactyly (extra digits) & mental retardation.

Front 67

What is Microphthalmia?

Back 67

Abnormally small size of one or both eyes.

Front 68

What can Coloboma cause?

Back 68

Decreased visual aculity, nystagmus, strabismus, photophobia & loss of visual fields.

Front 69

What are the S/Sx of Coloboma?

Back 69

Photophobia
Decreased to no vision in the effected eye.
Loss of depth perception.
Cosmetic effects.

Front 70

Coloboma Tx;

Back 70

Cosmetic contact lenses & or sunglasses for colobomas of the iris.
Optical aids.
Surgery to repair the lids.

Front 71

What is Epicanthus?

Back 71

Vertical fold of skin that lies over the medial canthus.
(is normal in Asians) (seen in Down's syndrome & other congenital conditions.

Front 72

What does Epicanthus falsely suggest?

Back 72

Convergent strabismus.

Front 73

What is Dermatocholasis?

Back 73

Redundant & lax eyelid skin & muscle. Common in elderly & occasionally in young adults.

Front 74

What causes Dermatocholasis?

Back 74

Gravity, loss of elastic tissue in the skin, & weakening of the connective tissues of the eyelid. (more common in the upper eyelids)

Front 75

Dermatocholasis Etiology (Dz)?

Back 75

Thyroid eye dz, Renal failure, trauma (cutis laxa), Ehlers-Danlos syndrome, Amyloidosis, hereditary angioneurotic edema, Xanthelasma, Genetic factors.

Front 76

Dermatocholasis Pathophysiology;

Back 76

(aging issues) Loss of elastic fibers, thinning of the epidermis, redundancy of the skin, associated w/dermatitis (a nonspecific chronic infiltrate is seen), The pathology of blepharochalasis typically shows loss of elastic fibers, lymphedema, epithelial atrophy, & vasculitis.

Front 77

Dermatocholasis S/Sx;

Back 77

Superior visual field obstructed, ocular irritation, entropion of the upper eyelid, ectropion of the lower eyelid, blepharitis & dermatitis, fullness or heviness of the upper leyelids, bags in the lower eyelids (fat herniation), wrinkles in the lower eyelids & lateral canthus.

Front 78

How much of visual field can be lost with Dermatocholasis?

Back 78

>50%

Front 79

Dermatocholasis Tx;

Back 79

Surgery
Pts w/blepharitis, lid hygiene & topical ABX.
Pts w/dermatitis, topical steroid ointment.
Pts w/dry eyes, topical lubricant,collagen puncial plugs, puncial cautery.

Front 80

Define Blepharospasm;

Back 80

Blink more frequently than normal, spontaneous involuntary forced blinking.

Front 81

Blepharospasm Tx;

Back 81

Anticholinergics, Phenothiazines of haloperidol, botulinum injections.

Front 82

Conjunctivitis Pathophysiology;

Back 82

Acute conjunctival inlammation, caused by bacteria or allergy.

Front 83

What can cause Conjunctivitis?

Back 83

Wind, dust, smoke, air pollution, intense ultraviolet light of electric arcs, sunlamps, reflection of snow.

Front 84

What virus most commonly causes Viral Conjunctivitis?

Back 84

Adenovirus

Front 85

What are the S/Sx of Viral Conjunctivitis?

Back 85

Hyperemia, Watery discharge, Ocular irritation, Eyelids truck together in AM, Bilateral (usually starts in one eye), contract w/someone w/same, recent URI, Prequricular lymphadenopathy w/tenderness. Severe cases; Photophobia, foreign body sensation, pseudomembranes of fibrin lead to scarring.

Front 86

Viral Conjunctivitis Tx;

Back 86

Highly contagious, good hand washing, self limiting 1 wk, Treat w/ABX if sign of bacterial inf., No patching, good eye hygeine.

Front 87

What is Bacterial Conjunctivitis?

Back 87

Inflammation caused by nongonoccal bacterial infection. (Staph aureus, Strep Pneumoniae, Hib.)

Front 88

Bacterial Conjunctivitis S/Sx;

Back 88

Purulent discharge, ocular irritation, eyelids stuck together, more unilateral, intense hyperemic & edematous conjunctivae, enlarged pre-auricular lymph node.

Front 89

Bacterial Conjunctivitis Tx;

Back 89

Cultrue discharge, Avoid transmitting, good handwashing, do not patch, self limiting 3 weeks, Sulfacetamide sodium 10% gtts or trimethoprim/polymuxin B QID for 7-10 days.

Front 90

What is Gonococcal Conjunctivitis?

Back 90

Rare, severe, purulent conjunctivitis in adults that is acquired from a gonorrheal contact or from self-inoculation during a gonorrheal genital infection.

Front 91

Gonococcal Conjunctivitis S/Sx;

Back 91

Unilateral, Severe eyelid edema, Chemosis (edema of conjunctiva), Profuse purulent exudate.

Front 92

Gonococcal Conjunctivitis Complications;

Back 92

Ulcers
Abscess
Perforation
Blindness

Front 93

Gonococcal Conjunctivitis Tx;

Back 93

Rocephine 1gm IM or Ciprofloxin 500mg BID po X5days and Bacitracin or gentamicin opthalmic ointment. Tx parteners as appropriate.

Front 94

Define Allergic Conjunctivitis;

Back 94

Acute seasonal conjunctival inflammation caused by an allergy (generally air borne pollens).

Front 95

Allergic Conjunctivitis S/Sx;

Back 95

Watery discharge, Ocular itching, Rhinitis, May have eczema or asthma, Seasonal symptoms, Bulbar & tarsal conjunctivae are hyperemic but predominately deematous.

Front 96

Allergic Conjunctivitis Tx;

Back 96

Topical OTC or antihistamine, OTC vasoconstrictors, NSAIDs, Topical mast cell inhibitors. (With caution topical corticosteroids in recurrent cases)

Front 97

What is Pterygium?

Back 97

Vascularization (or tissue) extending into the nasal aspect of the cornea, pt asymptomatic.

Front 98

Pterygium S/Sx;

Back 98

Vascularized pterygium may become red & inflamed, motivating pt to seek care.
Iregular surface can interfere w/stability of precorneal tear film, creating dry eye syndrome.
Rarely the pterygium may obscure the visual axis.

Front 99

Pterygium D/Dx;

Back 99

Ptergia must be distinguished from pingueculae.
Ptergia is more yelow in color & lies within the interpalpebral space, but does not encroach beyond the limbus.
pingueculae is more oval & ameboid in appearance.

Front 100

Pterygium etiology;

Back 100

Ultraviolet light exposure, Allergens, noxious chemicals & irritants, Heredity.

Front 101

Pterygium Pathophysiology;

Back 101

Conjunctival stroma replacement by thickened, tortuous elastotic fibers. Activated fibroblasts in the leading edge of the pterygium invade & fragment Bowman's layer & superficial corneal stroma. Pterygium development resembles actinic degeneration of the skin.

Front 102

Pterygium Tx;

Back 102

Avoid environmental factors. If inflammed or irritated tx w/topical decongestant/antihistamine &/or mild topical corticosteroids. Surgery sometimes is indicated.

Front 103

Sjogren's Syndrome in a nutshell;

Back 103

From lymphocytic infiltration, drying of mucus membranes, associated w/SLE & RA, Tx same as for Keratoconjunctivitis Sicca.

Front 104

What is a Pinguecula?

Back 104

Yellowish, slightly raised, interpalpebral lipid-like, deposits in the nasal & temproal conjunctiva.

Front 105

Pinguecula Pathophysiology;

Back 105

Older population, conjunctival degenerative process by exposure to noxious environmental stimuli & UV light. Solar radiation alters the collagen & elastic tissues of the conjunctival stroma, leads to elastotic degeneration & deposition of abnormalelastic fibers in the conjuctival substantia propria.

Front 106

Pinguecula Tx;

Back 106

Sunglasses, ocular lubricating drops, for inflammation use appropriate topical steroids, surgical resection in severe cases (interfere w/vision)

Front 107

What is a Subconjunctival Hemorrhage?

Back 107

Collection of blood under the ocular conjunctiva.

Front 108

What are some causes of Subconjunctival Hemorrhage?

Back 108

Can occur at any age, monor trauma, straining, sneezing, coughing, spontaneously,

Front 109

Subconjunctival Hemorrhage Tx;

Back 109

Absorbed spontaneously, self limiting in 2 wks. Reassure, Restrict activity (lifting, etc.) If pt is on anticoagulants, check bleeding times.

Front 110

What is Keratitis?

Back 110

Inflammation of the cornea.

Front 111

Keratitis Etiology;

Back 111

Bacterial, viral or fungal infections or may be non-infective, due to trauma or associated w/an auto-immune dz.

Front 112

Keratitis S/Sx;

Back 112

Painful red eye, reducted visual aculity due to cellular infiltration, Corneal edema, Circumcorneal Injection, Photophobia.

Front 113

Corneal Ulcer Etiology;

Back 113

Staph, Strep, Herpes Simplex or Zoster, Adenovirus, Rubeola, Rubella, Mumps, Trachoma, Infectious Mono, Pneumococcus, Vitamin A deficiency, Broad spectrum ABX drug reaction, Trauma.

Front 114

Corneal Ulcer S/Sx;

Back 114

Grayish white opacities, circumcorneal injection or hypopyon.

Front 115

Corneal Ulcer Procedures;

Back 115

Fluorescein staining & exam under slit lamp will reveal corneal ulcers.

Front 116

What causes corneal scars;

Back 116

Deep; Abrasion, Laceration, & Burns
Disease

Front 117

Corneal Scar Tx;

Back 117

If scarring is deep enough to effect vision, corneal transplant.

Front 118

What is Arcus Senilis?

Back 118

A gray-white arc or circle lipid deposit around the limbus. Is benign & does not affect vision.

Front 119

What is Uveitis?

Back 119

Inflammation of any component of the uveal tract (iris, cillary body or choroid)

Front 120

What is Retinitis?

Back 120

Inflammation of the overlying retina. (can occur w/uveitis)

Front 121

What is Neuritis?

Back 121

Inflammation of the optic nerve. (may occur w/uveitis)

Front 122

What is Anterior Uveitis?

Back 122

Localized primarily to the anterior segment of the eye and includes iritis & iridocyclitis.

Front 123

Anterior Uveitis S/Sx?

Back 123

Pain, Redness, Photophobia, Decreased vision, Pupillary miosis, Perilimbal flush, visual acuity not impaired, haziness, accommodative tasks more difficult & uncomfortable, mild to moderate congestion of the lids, resulting in pseudpotosis, IOP in affected eye is initially decreased.

Front 124

What do slit lamp findings include w/Anterior Uveitis?

Back 124

"Cells & flare" in the aqueous humor. (flare is protein from inflamed iris or ciliary body which gives the aqueous a particulate or smoky appearance.

Front 125

What is Secondary Uveitic glaucoma?

Back 125

Inflammatory by-products accumulate in the trabeculum. This debris builds significantly & the ciliary body resumes its normal output the IOP may rise sharply.

Front 126

What is Intermediate Uveitis (Peripheral Uveitis)?

Back 126

It is centered in the area immediately behind the iris & lens in the region of the ciliary body & pars plana. It includes; Retinitis, Choroiditis & Optic Neuritis.

Front 127

What is Diffuse Uveitis?

Back 127

Implies inflammation involving all parts of the eye, including anterior, intermediate & posterior structures.

Front 128

Uveitis etiology;

Back 128

May be associated w/underlying systemic dz.
May occur as a result of ocular trauma.
Inflammatory reactions in adjacent tissues can induce a secondary uveitis.

Front 129

Which systemic diseases can cause Uveitis?

Back 129

Anklosing spondylitis, Behcet's syndrome, Inflammatory bowel dz, Juvenile TA, Reiter's syndrome, Sarcoidosis, Syphilis, TB, Lyme dz.

Front 130

Which labs should be ordered to R/O systemic dz w/Uveitis?

Back 130

CBC w/differential, ANA, HLA-B27, rheumatoid factor, Angiotensin-converting enzyme, Florescent treponemal antibody absorption, Rapid plasma reagin (RPR), Chest X-ray, Lyme titer, PPD.

Front 131

Uveitis complications;

Back 131

Profound & irreversible loss of vision (cataract), Glaucoma, Retinal detachment, Neovascularization of the retina, optic nerve or iris. Cystoid macular edema.

Front 132

What is the most common cause of decreased vision from uveitis?

Back 132

Cystoid macular edema.

Front 133

Uveitis Tx;

Back 133

Immediate referal to ophthalmologist.
1.Immobllize the iris & cillary body.
2.Quell the inflammatory response. Cyclopleging the pt w/homatropine 5% TID/QID, scopolamine 0.25% BID/QID or atropine 1%BID. Topical steroid q 2-3h. Re-eval q 1-7 days.

Front 134

What is Glaucoma?

Back 134

Group of disorders, Open Angle (chronic) & Closed or Narrow Angle (Acute), that is characterized by damage to the eye due to IOP.

Front 135

Which form of Glaucoma is the most common?

Back 135

Open Angle

Front 136

Open Angle Glucoma PE;

Back 136

IOP decreases blood supply to the retinal structures.
The physiologic cup enlarges to more than 1/2 of the disc.
Vessels are displaced nasally.

Front 137

Open Angle Glaucoma S/Sx;

Back 137

Usually bilateral. There are no early Sx, no pain, & visual impairment is not noticed until optic nerve damage is significant. (tunnel vision)

Front 138

What are some causes of Cataracts?

Back 138

Congenital, Uveitis, Glaucoma, Aging, Neoplasia, Steriods & Miotics, Trauma, Maternal Infection, Chromosomal abnormalities, Hereditary disorders, Metabolic disorders, Cigarette smoking, & heavy ETOH use.

Front 139

What are Moitics?

Back 139

Makes pupil smaller
Constricts Pupil

Front 140

What are Mydriatics?

Back 140

Makes pupil stay open
Dilates Pupil

Front 141

Which is the most common kind of cataract?

Back 141

Nuclear Cataract

Front 142

Nuclear Cataract Etiology;

Back 142

Aging p 40, Opacity is in the central lens nucleus (the pit), develops slowly, can induce myopia in the presbyopic pt., Temporary improvement in sight may occur (this disappears as the cataract evolves).

Front 143

How do Nuclear Cataracts present?

Back 143

As an opaque gray area surrounded by a black background.

Front 144

Cortical Cartact (Star Shaped Opacity) PE;

Back 144

Forms in the outer cortex of lens, progressing faster than nuclear cataract, begins as wedge-shaped spokes, spokes extend from the outside of the lens to the center.

Front 145

How do Nuclear Cataracts present (opthalmascope)?

Back 145

May appear as a black center against the red reflex.
A large nuclear cataract will obliterate the red reflex.

Front 146

Cortical Cartact (Star Shaped Opacity) PE (opthalmascope);

Back 146

"Black spokes" are visible against the red reflex.

Front 147

What is a major risk factor for a Cortical Cartact (Star Shaped Opacity)?

Back 147

DM

Front 148

Does a Cortical Cartact (Star Shaped Opacity) affect vision?

Back 148

Yes, May impair distant & near vision significantly, requiring surgery at an early stage.

Front 149

Subcapsular Cataract Etiology;

Back 149

Develops slowly as a small opacity under the capsule, usually in the lens posterior region.

Front 150

Does the Subcapsular Cataract impair vision?

Back 150

Impairment may not occur until cataract is well developed. Vision is affected because the opacity is located at the crossing point of the light rays from the viewed object.

Front 151

Subcapsular Cataract S/Sx;

Back 151

Glare & Blur

Front 152

Risk factors for Subcapsular Cataract;

Back 152

DM
Severely myopic pts
Adults w/retinitis pigmentosa
Steroid use

Front 153

What is a Morgagnian Cataract?

Back 153

This cataract has been allowed to mature to where the lens cortex has become liquefied.

Front 154

Can a Morgagnian Cataract be removed?

Back 154

It must be removed because the lenses tend to leak & can produce phacoanaphylaxis, whish causes blindness.

Front 155

Is a Morgagnian Cataract difficult to remove?

Back 155

Yes, because the capsule is friable & splits easily. The nucleus is very hard & is no longer trapped by the cortex.

Front 156

Morgagnian Cataract PE;

Back 156

The lens nucleus is seen as the brownish discoloration near the capsule bottom.

Front 157

Morgagnian Cataract S/Sx;

Back 157

Vision problems depending on the progression, Sensitivity to light & glare, Increased nearsightness, & Blurred vision.

Front 158

What is a Cataracts?

Back 158

Clouding of the natural lens. Leading cause of visual loss among adults >55.

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Cataracts Patho;

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The lens is responsible for focusing light & producing images, is contained in a capsule as old cells die they become trapped within the capsule. Overtime the cells accumulate causing the lens to cloud.

Front 160

Name some causes of Cataracts;

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Eye injuries
Medications
DM
Alcholism

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Cataracts D/Dx;

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Corneal Scarring
Keratitis

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Cataracts Tx;

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Referral for excision & lens implantation. Visual acuity improves in 95% of cases.

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Arcus Senilis Etiology;

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A common bilateral peripheral corneal condition. (can be related to hyperlipidemia)Found in 60% of people 40-60yrs (more common in blacks)

Front 164

Arcus Senilis Patho;

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The opacity is due to deposits of lipid droplets in the superficial & deep layers of the cornea. These deposits form the characteristic yelowish-white ring.

Front 165

What is secondary glaucoma?

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Glaucoma secondary to an intraocular disorder. Usually anterior uveitis or; Intraocular tumor, Enlarged cataracts, Central retinal vein occlusion, trauma, surgery, Intraocular hemorrhage, prolonged corticosteroid therapy.

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Secondary glaucoma due to Steroid therapy?

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Especially topical, (Steroid responders particularly sensitive) Can occur after 1 week of tx but typically 6 to 8th week, usually subsides by withdrawing steroids.

Front 167

Secondary glaucoma tx;

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Referral to ophthalmologist.

Front 168

Chronic Open Angle Glaucoma Eitology;

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Gradual rise in IOP, Insidious loss of peripheral vision, eventual blindness if uncontrolled.

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Chronic Open Angle Glaucoma PE;

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Anterior chamber structures apperar normal, imbalance between production & outflow obstruction, outflow impedance is mainly responsible, Vasomotor & emotional instability are contributors. Rarely unilateral.

Front 170

Chronic Open Angle Glaucoma Risks;

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DM, Myopia, Family hx, Pigment dispersion syndrome (Krukenberg's spindle),Blacks 4-5 times higher risk compared to whites.

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Chronic Open Angle Glaucoma S/Sx;

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>35yrs, frequent changes in eye glasses Rx, Mild H/A, Vague visual disturbances, Halos around electric lights, impaired darkness adapation.

Front 172

Chronic Open Angle Glaucoma PE;

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Single isolated normal pressure doesn't R/O glaucoma. Pressure rise in early glaucoma may be intermittent. Cupping of the optic disk is characteristic. Changes are insidious, a normal appearing disk doesn't R/O glaucoma.

Front 173

Chronic Open Angle Glaucoma Early visual signs;

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Early visual field changes may be subtle, a small scotoma above or below fixation, subtle nasal peripheral field defects, external eye appears normal.

Front 174

Chronic Open Angle Glaucoma Tx;

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Pilocarpine 0.5%
Timolol maleate
Betaxolol

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Chronic Open Angle Glaucoma Tx Complications;

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Tx w/powerful miotics may cause cataracts or retinal detachmant. Avoid; Fatigue, Emotional upset, & Nicotine. Monitor intake of fluids.

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Chronic Open Angle Glaucoma F/U;

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Semi-annual tonometry
Laser trabeculoplasty

Front 177

What is acute Angle-Closure Glaucoma?

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Sudden attack of increased intraocular pressure. S/Sx caused by acute obstruction of the aqueous drainage of the eye.

Front 178

What is acute Angle-Closure Glaucoma S/Sx?

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Usually unilateral, Severe pain, Hazy, Steamy Cornea, w/severe pain. Loss of vision.

Front 179

Angle-Closure Glaucoma Prodrome-transitory episodes S/Sx;

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Diminished visual acuity, colored halos around lights, pain in the eye &/or head, pupil dilated & sluggish, Shallow anterior chamber, may last several hours.

Front 180

What is acute Angle-Closure Glaucoma Acute attack S/Sx?

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Hazy, Steamy Cornea, Rapid loss of sight, Severe throbbing pain in the eye, 5th cranial (trigeminal) distribution, Nausea & vomiting, Upper lid edema, Lacrimation, circumcorneal injection, Chemosis, Fixed Dialated pupil.

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What is acute Angle-Closure Glaucoma Tx?

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Oral glycerin 1-2gm/kg mixed 1:1 w/H2O (aborts attack & rapidly lowers IOP).
Oral carbonic anhydrase Inhibitors (Acetazolamide 500mg)
Topical miotics (Pilocarpine 4%q 15min.
Immediate Referral!!!

Front 182

What is Glaucomatocyclitic crisis (Posner-Schlossman syndrome)?

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Recurrent monocular rise in pressure, Simulates acute angle-closure.

Front 183

How is Glaucomatocyclitic crisis (Posner-Schlossman syndrome) differentiated from Acute Angle-Closure Glaucoma?

Back 183

Normal anterior chamber depth, Keratic, precipitates, other signs of uveitis.

Front 184

Glaucomatocyclitic crisis (Posner-Schlossman syndrome) Tx;

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Responds to topical steroids & carbonic anhydrase inhibitors. (Surgery is usually contrindicated)

Front 185

What happens in Absolute Glaucoma's final stage?

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Blindness from atrophy of retinal nerve head, Pupil dilated & fixed, Iris atrophied, Optic disk deeply excavated, No pain, the eyeball subsequently degenerates.

Front 186

Retinal Artery Occlusion Exam;

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Small occlusion-Flame shaped hemorrhage, "Cotton wool" spot.
Large occlusion-"Cherry red spot" in area of macula.

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Retinal Artery Occlusion Tx;

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Intermittent digital pressure to globe to dislodge embolus. Increase pCO2 to dilate artery. Urgent ophthamological consult.

Front 188

Retinal Artery Occlusion S/Sx;

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Painless
Sudden Monocular visual loss
May have several 'attacks' of blindness before final event.

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Causes of Retinal Artery Occlusion;

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Embolism
Thrombosis

Front 190

Causes of Retinal Vein Occulsion;

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Thrombosis

Front 191

Retinal Vein Occulsion S/Sx;

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Monocular visual loss
Vision decreases over hours

Front 192

Retinal Vein Occulsion Exam;

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"blood-&-thunder' optic fundus
Massive hemorrhage covers retinal surgace & dilated veins.

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Retinal Vein Occulsion Tx;

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No immediate tx, Deficits are ofter reversible.
Look for underlying cause; HTN, Glaucoma, DM

Front 194

Retinal Vein Occulsion Referral;

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Pts need continous f/u w/ophthalmologist, Neovascularizaion of the retinal or iris probable, vitrectomy a surgical option.

Front 195

Waht is Retinal Detachment?

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Separation of the neurosensory layer from the underlying pigmented epithelium.

Front 196

Retinal Detachment S/Sx;

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Visual loss
Cloudy vision
"floaters"
Flashes of light
"Black curtain" across their vision.

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Retinal Detachment Risk Factors;

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Aging, Myopia, Eye surgery, Inflammation, Trauma, Prior Retinal Detachment, Family Hx of Retinal Detachment, DM w/retinal hemorrhages.

Front 198

Retinal Detachment Exam;

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Retina appears gray or opaque.
Arterioles & venules appear dark.
Floater may be visualized.

Front 199

Retinal Detachment Tx;

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Emergent referral for surgical correction (laser welding)

Front 200

What is the most common cause of blindness in middle adulthood?

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Diabetic Retinopathy