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232 Cards in this Set
- Front
- Back
Why evert the upper eyelid?
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To examine the tarsal conjunctiva for foreign body
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How do you evert the upper eyelid?
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1) Ask the patient to look down
2) Apply slight pressure with a q-tip or finger 3) Pull the lid margin up gently |
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How do you test accommodation?
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1) Ask patient to fixate on an object far away
2) Ask patient to refocus on an object about 10cm away |
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What can corneal light reflex tell you?
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Whether there is convergent/divergent squint or pseudosquints.
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Why does one check for Red Reflex?
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It shows:
1) Dark areas --> corneal, lens, or vitreous opacity 2) Gray color --> retinal detachment |
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Why should you approach temporally when trying to look at the fundus?
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Because you want to see the disc before the pupil contracts. The pupil will contract once light hits the macula.
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What are six difficulties in fundus examination?
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1) Uncooperative patient
2) High myopia 3) Corneal, lens, or vitreous opacity 4) Poor ophthalmoscope 5) Bright room 6) Small pupils |
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What is a comon short-acting mydriatic used for looking at the fundus?
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Tropicamide
1) acts in less than 30 minutes 2) lasts for about 4 hours (Note: atropine is a bad choice b/c it lasts for a week) |
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What can the cover-uncover test reveal?
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A squint
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What is a synoptophore?
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A machine with specially designed pictures to measure accurately the angle of a squint and to test the ability of the patient to see with both eyes together (biocular single vision).
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What is gonioscopy?
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Checking the filtrating angle of glaucoma patients.
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What is tonometry?
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The measurement of intraocular pressure (IOP).
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What is the most commonly used tonometer?
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The Goldmann Applanation Tonometer.
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What is perimetry?
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A more accurate measurement of visual fields using a small 5mm target moving into view from the periphery.
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What is Scotometry?
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The measurement of visual field deficits using a small target on a screen. It generally assesses the central 30 degrees of the field of view.
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Where is the blind spot found?
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15 degrees lateral to the point of fixation.
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What can computerized visual field testing/perimetry allow for?
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Screening for glaucoma and pituitary tumors.
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What are the most common tests for color vision?
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Ishihara test and Farnsworth Munsell 100 hue test
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What does fundal fluorescein angiography involve?
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1) Fluorescein dye is injected intravenously
2) serial fundal photgraphs are taken to show the retinal and choroidal circulation. |
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What is ultrasound used for in the eye?
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1) evaluate the posterior segment when the ocular media is opaque.
2) measure corneal thickness 3) measure axial length of eye 4) provide data required lens power for an IOL implantation |
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What is CT particularly useful for in ophtho?
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1) Orbital tumors
2) Localization of intraocular foreign bodies 3) Neuro-op disorders |
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What is MRI particularly useful for in ophtho?
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1) Soft tissue changes
2) Demyelinating lesions |
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What are ways of measuring Macular Potential Acuity (the acuity one can achieve after a procedure)?
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1) test acuity with pinhole
2) Potential Acuity Meter (PAM) 3) Laser inferometer 4) Blue Field entoptoscope |
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What is Electroretinography (ERG) useful for?
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1) Diagnosis of retinal dystrophy (e.g. retinitis pigmentosa)
2) Assessing visual function in vitreous hemorrhage |
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What is Electrooculography useful for?
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It measures retinal pigment epithelial function
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What is Visual Evoked Response useful for?
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It indicates whether there is optic nerve disease (decreased response).
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What does slit-lamp examination allow?
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1) magnified examination of anterior segment
2) examination of filtration angles 3) IOP measurement with applanation tonometer 4) vitreous and retinal examination with special contact lens |
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What does indirect ophthalmoscopy allow?
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Good binocular examination of retinal periphery. This is especially useful in retinal detachment or cloudy media.
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Optic disc color
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1) Pink
2) Temporal side usually paler |
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Optic disc margin
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1) sharp and flat
2) nasal margin may be relatively blurred and raised (in hypermetropia) 3) There are many normal variations (e.g. pigmentation, myopic crescent) |
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Optic disc -- cup
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1) varies in size and depth
2) situated at center of disc and slopes temporally |
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Cup/disc ratio
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the ratio of the diameter of the optic disc cup to the optic disc
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Retinal vessel color: Which are lighter -- arteries or veins?
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Arteries
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Retinal vessel diameter
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1) arteries are narrower than veins
2) ratio of artery to vein diameter is about 2:3 |
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Retinal vessel crossing -- do arteries or veins cross anteriorly?
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Arteries cross anterior to veins at arteriovenous crossing
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Fundus background color
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1) fundal background is red b/c of choroidal vessels and retinal pigment layer
2) fundal bg is darker in pigmented races 3) in lightly-pigmented people, large choroidal vessels are seen against the white sclera 4) the fundal bg has a tesselated (tigroid) appearance in myopia -- stretch marks? |
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Macular area color -- is it darker or lighter than the rest of the fundus?
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Darker than the rest of the fundus. At the center, there should be a normal foveal light reflex.
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What 3 things are most lid conditions related to?
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1) inflammation
2) malposition 3) tumors |
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What is the most common condition of the orbit?
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Exophthalmos. It indicates the possibility of thyroid disease or a space-occupying lesion.
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Blepharitis
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Inflammation of the lid margin
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What are the two main types of blepharitis?
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1) Squamous blepharitis
2) Ulcerative blepharitis |
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Squamous blepharitis
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1) Associated with dandruff or seborrheic dermatitis
2) presents with small white scales at the roots of the eyelashes 3) eyes are chronically irritable |
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Ulcerative blepharitis
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1) due to staph infection of follicles at the lid margin
2) accompanied by loss of lashes, deformity of lashes (trichiasis) |
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Treatment for blepharitis
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1) removal of crusts with boiled cotton wool
2) antibiotic ointment for ulcerative blepharitis 3) lotion to control dandruff in squamous blepharitis |
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Stye (hordeolum)
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1) A small abscess of the eyelash follicle
2) seen clinically as a small inflamed nodule Sx: 1) acute irritation 2) local pain Tx: 1) local heat (warm compress) 2) removal of follicle 3) optional abx |
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Chalazion (Meibomian cyst)
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Defn:
Blockage of the duct of a tarsal gland that leads to a cyst Pres: painless nodule at the tarsal plate becomes inflamed Tx: 1) local heat 2) topical abx 3) systemic abx (rare) 4) surgery (if large) |
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Allergic or Contact Dermatitis
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Defn: allergy due to cosmetics/medication (often sulfas) causes edema, inflammation of skin around eyelids
Tx: 1) stop exposure/med 2) topical steroid cream |
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Herzes zoster opthalmicus (HZO)
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Pres:
Pain and skin vesicles (which may become secondarily infected) in the distribution of V-1 If the nasociliary nerve is affected --> skin lesions on one side of the nose and risk to eye of: 1) corneal inflammation 2) iridocyclitis 3) secondary glaucoma Tx: 1) general hygiene 2) local abx to prevent 2ary infxn 3) local steroids to eye if keratitis or irdocyclitis 4) antivirals in acute phase After: can experience post-herpetic nerualgia -- prolonged pain over scalp and eye |
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Ptosis
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Defn: drooping upper lid
Types: 1) unlitateral/bilateral 2) complete/partial 3) congenital/acquired |
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What does a patient with bilateral ptosis look like?
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They will have their head tilted backwards so that they can see through the narrowed palpebral fissure
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Congenital ptosis
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Cause: dystrophy of levator palpebrae sperioris muscle
NH: can lead to amblyopia Tx: 1) surgery to shorten LPS muscle |
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What are the causes of acquired ptosis?
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1) senile degneration of levator aponeurosis
2) CN III lesion 3) Horner's syndrome 4) myasthenia gravis, other myopathies 5) trauma to lids 6) inflammation of lid 7) tumor |
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Lid Retraction
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Defn: The upper lid does not cover the upper edge of the cornea
Causes: 1) overactivity of levator muscle from hyperthyroidism Tx: 1) Control of hyperthyroidism, if that is the cause 2) Plastic bridging of the lens (tarsorraphy) 3) recession of the levator muscle |
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Entropion
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Defn: Inversion of the lid margin. It is associated with inturned eyelashes (trichiasis)
Cause: 1) scar tissue of the conjunctival surface (common in end-stage trachoma) 2) spasm of orbicularis oculi (spastic entropion) 3) weakness of eyelid tissues (senile entropion) Cmplx: 1) chronic conjunctivitis 2) corneal abrasion 3) corneal ulceration Tx: 1) lubricants 2) surgical eversion of the lid |
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Ectropion
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Defn: eversion of lid margin
Sx: 1) tearing (epiphora) due to failure of tears to access the lacrimal drainage apparatus 2) exposure conjunctivitis or keratitis Cause: 1) weakness of orbicularis oculi -- CN VII lesion or senile weakness 2) scar tissue on skin of eyelid (cicatricial ectropion) Tx: If disruptive, surgery to restore eyelid to normal position |
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Trichiasis
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Defn: inturned eyelashes
Sx: 1) unilateral red eye from chronic irritation of the cornea or conunctiva 2) Associated with entropion Tx: 1) destruction of follicles of inturned lashes by diathermy or cryotherapy 2) surgical eversion of eyelid |
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Xanthelasma
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Defn: fatty deposit in the skin, usually bilateral and occurring at the medial part of the upper lid. can sometimes develop on lower lid
Sx: none Tx: surgical removal solely for cosmetic improvement |
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Basal cell carcinoma (rodent ulcer)
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Pres: Appears on the lower lid margin as a raised nodule with a pearly rolled edge
Cmplx: 1) ulceration 2) infiltration into adjacent tissues --> can lead to loss of eye or bone invasion Does not metastasize Tx: 1) surgery 2) radiotherapy |
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What are consequences of blockage of the nasolacrimal duct?
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1) tearing
2) infxn of lacrimal sac (chronic dacrocystitis 3)reflux of mucopurulent material when pressure is applied to lacrimal sac |
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What is a dacryocystorhinostomy?
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The creation of a new drainage channel in response to dacryocystitis
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Orbital cellulitis
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Pres:
1) unilateral, intesnse lid edema 2) chemosis (edema of the conj) 3) restriction of eye movements Cause: 1) spread of infection to the orbit from one of the paranasal sinuses Cmplx: 1) cavernous sinus thrombosis (can be fatal) Tx (urgent): 1) systemic abx 2) x-ray of sinuses 3) ENT consult |
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Preseptal cellulitis
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Milder than orbital cellulitis
Pres: 1) swollen, inflamed lids 2) no proptosis 3) no change in ocular movements Tx: 1) abx |
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Exophthalmos
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Defn: proptosis or forward protrusion of the eyeball
Pres: 1) lower lid margin no longer covers limbus Cause: 1) thyroid dz 2) space occupying lesion behind eyball (optic nerve tumor, hemangioma, lymphangioma from middle, meningioma, nasopharyngeal cancer, metastatic tumors) Should be distinguished from lid retraction and myopia Tx: 1) removal of space-occupying lesion 2) protection of cornea, potentially with tarsorraphy (plastic bridging of lid) |
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Bacterial conjuunctivitis
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Pres:
1) bilateral red eyes 2) yellowish mucopurulent discharge, sticky eyelids in morning 3) gritty/foreign body sensation in eye Tx: 1) local antibiotic eyedrops every three hours |
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Viral conjucntivitis
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Pres:
1) bilateral watering red eyes 2) photophobia with associated keratitis 3) preauricular and submandibular lymphadenopathy 4) fever + URI Tx: 1) none 2) steroids if corneal involvement 3) abx if concern of bacterial infxn |
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Allergic conjunctivitis
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Pres:
1) intense pruritis 2) watering red eyes Cause: 1) vasomotor rhinitis 2) drug/cosmetic rxn 3) hay fever Tx: 1) antihistamine (eyedrop + oral) 2) no steroids |
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Spring catarrh (vernal conjunctivitis)
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Pres:
1) large flat papillary conjunctival thickenings on upper tarsal conjucntiva Tx: 1) steroid drops |
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Chronic non-specific conjunctivitis
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Sx:
1) dryness 2) irritation 3) burning 4) redness 5) watering 6) pain Worse on exposure to all types of irritants |
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Dry Eye (keratoconjunctivitis sicca)
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Cause:
1) defective tear formation 2) Sjogren's (dry eyes, dry mouth, arthritis) 3) RA 4) SLE 5) Sarcoidosis 6) Stevens Johnson's syndx Cmplx: 1) corneal ulceration Tx: 1) tear substitues 2) punctal plugs 3) tarsorrhaphy |
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Unilateral red eye
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1) Dangerous!
Cause: 1) acute closed-angle glaucoma 2) irits 3) keratitis 4) corneal ulcer 5) foreign body 6) scleritis 7) acute closed angle glaucoma |
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Subconjunctival hemorrhage
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Pres:
1) unilateral red eye Cause: 1) rubbing of eyes or severe coughing --> capillary rupture --> sub-conj hemorrage Tx: 1) None -- takes 2 wks to reabsorb 2) Exclude blood dyscrasia if recurrent |
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Trachoma
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Cause:
1) Chlamydia trachomatis Pres: 1) acute conjunctivitis 2) Herbert's pits -- follicles at the limbus at the limbus that indicate infxn 3) pannus formation in upper cornea 4) cyclical reinfection 5) bacterial superinfection 6) entropion 7) trichiasis Tx: 1) local abx (tetracycline) 2) oral abx (sulfa) 3) surgical correction of entropion/trichiasis |
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Pinguecula
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Defn:
1) tiny, cream-colored, slightly raised opaque lesion on conj, usually nasal Sx: 1) none Cause: 1) sun exposure Tx: 1) none 2) cosmetic surgical removal |
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Pterygium
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Defn:
1) a triangular fleshy wing of conj that encroaches on cornea, usually nasal side 2) some are thick/fleshy, some are avascular/flat 3) can cause mild astigmatism Cause: 1) sun exposure Tx: 1) surgical excision if encroaches on cornea by >= 3 mm, exposed can be covered with conj. graft |
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Conjunctival melanoma (nevus)
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1) usually harmless
2) can be removed for cosmetic reasons 3) malignant conj melanoma is rare |
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What are common causes of corneal ulcer?
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1) HSV infxn
2) bacterial infxn 3) trauma 4) dry eye |
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HSV dendritic ulcer
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Defn: a serious infxn of the cornea caused by Herpes simplex virus
Cmplx: 1) disciform keratitis 2) recurrence during periods of stress 3) perforation Tx: 1) antiviral (icoxuridine 2) debridement 3) NO steroids, even if quiet! |
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Small marginal corneal ulcers
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Pres:
1) assoc with ulcerative blepharitis Cause: 1) hypersens. to Staph antigens Tx: 1) abx eyedrops 2) steroids |
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Bacterial corneal ulcer
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Dx:
1) unilateral red eye, painful, watering, photophobic Cause: 1) P. aeruginosa 2) staph 3) strep Risk factors: 1) contact lens wear 2) corneal trauma 3) immunosuppression Tx: 1) abx 2) gram stain, cultures for specific tx |
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Epiphora
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excessive tearing
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Complications of severe corneal ulcers
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Blindness from:
1) corneal scarring 2) corneal perforation 3) secondary glaucoma 4) panophthalmitis |
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Fungal corneal ulcer
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1) Poor prognosis
2) Often precipitated in immunosuppressed state (e.g. steroid tx) 3) Tx is local or systemic antifungals |
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What are common causes of corneal opacity?
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1) healed hsv keratitis
2) ulcer trachoma 3) trachoma 4) trauma 5) keratomalacia from vit A deficiency If severe, can be treated with corneal graft |
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Arcus senilis
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Defn:
1) a white ring at the periphery of the cornea 2) caused by lipd deposits in limbal area 3) does not affect central cornea 4) harmless |
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What are common corneal dystrophies?
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1) Keratoconus
2) Fuchs' endothelial dystrophy |
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Keratonus
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Defn:
1) dystrophic condition in young adults 2) cornea becomes conical in shape Cmplx: 1) myopia 2) severe irregular astigmatism Tx: 1) contact lenses 2) corneal graft |
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Fuchs' endothelial dystrophy
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Pres:
1) corneal edema 2) corneal opacity Cmplx: 1) Severe visual loss Tx: 1) Corneal graft |
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Non-ulcerative (interstitial) keratitis
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NH:
1) patch of vessels with corneal opacity 2) residual opacity 3) ghost vessels Tx: 1) local steroids 2) corneal graft |
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Common Indications for Corneal Graft
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1) post-cataract surgery bullous keratopathy
2) keratoconus 3) corneal dystrophies 4) corneal opacities 5) corneal ulcers |
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Hypopyon
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Pus in the anterior chamber
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Causes of cataracts
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1) develops over time (senile cataract)
2) trauma 3) drug toxicity (esp. steroids) 4) diabetes 5) hypoparathyroidism 6) uveitis 7) retinal detachment |
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Cataract definition
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An opacity in the clear lens taht blocks or scatters light rays.
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Methods of Cataract Removal
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1) Intracapsular method
2) Extracapsular method (including phacoemulsification) |
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Intracapsular Cataract extraction
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removal of the whole lens together with its capsule
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Extracapsular cataract extraction
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1) nucleus and cortex of lens are removed through an opening in the anterior capsule (anterior capsulectomy)
2) requires a good operating microscope 3) Ultrasonic disintegration of the lens nucleus (phacoemulsification) allows removal of the cataract through a small (3mm) incision |
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What are the differences between traditional extracapsular cataract extraction and phacoemulsification?
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Phacoemulsification gives:
1) faster rehab 2) less post-op astigmatism Traditional method: 1) less expensive 2) less equipment needed 3) essentially the same visual result |
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Why place an IOL after cataract surgery?
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1) to replace the lens without thick glasses or contacts
2) excellent post-op vision |
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Is cataract surgery inpatient or outpatient? What type of anesthesia is required?
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Outpatient. Usually, only local anesthesia is required.
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What are potential complications of cataract surgery?
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1) enophthalmitis (infxn of the entire eye)
2) wound leaks 3) glaucoma 4) severe astigmatism 5) opacification of posterior capsule 6) retinal edema 7) retinal detachment |
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What conditions can involve secondary cataract formation?
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1) iridocyclitis
2) retinal detachment 3) trauma |
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Glaucoma definition
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Damage to the optic nerve (usually due to increase in IOP)
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Open-angle glaucoma overview
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1) develops insidiously
2) slow and progressive damage to the optic nerve 3) visual loss with few or no other sx |
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Acute closed-angle glaucoma
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1) develops suddenly
2) involves pain 3) sudden visual loss 4) congestion of the eye 5) painful unilateral red eye |
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Primary open-angle glaucoma
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Cause:
1) defective trabecular meshwork at the filtration angle --> rise in IOP Dx: 1) visual field loss 2) glaucomatous cupping of the optic disc 3) (usually, but not always) increased IOP NH: 1) frequent changes of glasses 2) vague tiredness and ocular discomfort 3) increased difficulty reading |
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Ocular hypertension
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IOP greater than 20 mmHg. Is indicative, but not alone diagnostic of glaucoma
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Visual field loss in chronic open-angle glaucoma
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1) arcuate scotoma
2) loss of nasal visual field |
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Optic cup in glaucoma
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1) The optic cup is increased in size in glaucoma
2) a cup/disc ratio of > 0.5 is suspicious of glaucoma 3) In advanced chronic open-angle glaucoma, the cup reaches the edge of the disc and the retinal vessels dip sharply over the edge of the cup |
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Prevention of glaucoma
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1) difficult in open-angle glaucoma b/c of lack of sx
2) periodic IOP measurement in people over 40 yo 3) familial tendency, so make sure relatives of patients get examined |
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Medical therapy for glaucoma
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1) Pilocarpine -- cholinergic agonist
2) Timolol -- beta blocker 3) adrenaline 4) propine (adrenaline prodrug 5) acetazolamide (CA inhib) 6) latanaprost (prostaglandin agonist) 7) apraclonidine (Adrenaline agonist) 8) dorzolamide (CA inhib) 9) brimonidine (alpha agonist) New: neuroprotective agents |
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Surgical treatment for glaucoma
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1) laser trabeculoplasty (laser treatment of trabecular meshwork)
2) trabeculotomy -- communication btwn anterior chamber and outside of eyeball (sub-conj space) 3) trabeculectomy |
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Why are antimetabolites (mitomycin C, 5-FU) used in trabeculectomies?
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Antimetabolites (including mitomycin C and 5-FU) are used in trabeculectomies to prevent scarring.
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Acute closed angle glaucoma
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1) common in middle-aged pts
Cause: 1) iris periphery suddenly apposes itself to corneal periphery, blocking the filtration angle --> preventing aqueous outflow --> rise in IOP Pres: 1) unilateral red eye 2) blurred vision 3) pain/headache Signs: 1) epithelial edema --> corneal haze 2) semi-dilated, non-reactive pupil Tx (urgent): 1) medical 2) surgery (trabeculectomy, trabeculotomy) |
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Medical therapy for closed-angle glaucoma
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1) Pilocarpine (every 10 minutes for first hour)
2) IV acetazolamide 3) oral acetazolamide 4) osmotic agents (glycerol or mannitol) 5) analgesic |
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Surgical treatment for closed-angle glaucoma
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1) laser iridotomy (argon or YAG laser)
2) iridoplasty (contracting laser burns) 3) surgical peripheral iridectomy 4) traculectomy (if failed medical therapy) |
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What is the risk of closed-angle glaucoma in the second eye?
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50% in five years.
This is why prophylactic peripheral iridectomy or laser iridotomy should be performed on the second eye after acute closed angle glaucoma in the first eye. |
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Subacute closed angle glaucoma
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Sx:
1) transient blurred vision 2) seeing "halos" (rainbow colors around lights) Dx: by gonioscopy |
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Conditions resulting in secondary glaucoma
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1) iridocyclitis
2) hyphaema (blood in anterior chamber) 3) new iris vessels (rubeosis iridis) following central retinal vein occlusion or proliferative diabetic retinopathy --> hemorrhagic glaucoma (neovascular glaucoma) 4) complication of mature cataract 5) complication of intraocular tumor |
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Iridocyclitis (iritis)
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Defn: inflammation of the iris and ciliary body
Pres: 1) painful unilateral red eye 2) photophobia 3) mild pain 4) blurred vision 5) watering Findings: 1) flare (proteins) 2) white cell deposits (keratic precipitates on posterior surface of cornea 3) iris may adhere to anterior capsule of lens (posterior synechia) Cmplx: 1) secondary glaucoma 2) secondary cataract Cause: 1) joint dz (ankylosing spondylitis) 2) TB 3) viral infxn Tx: 1) cycloplegics (atropine, homatropine) to dilate pupil, relieve pain 2) steroid drops |
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Chorioretinitis
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Defn: inflammation of the choroid and the retina
Pres: 1) visual loss Cause: 1) usually unknown 2) toxoplasmosis 3) syphilis, TB, sarcoid, toxocariosis, histoplasmosis Tx: 1) systemic steroids 2) therapy for specific infxns |
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Benign choroidal melanoma (nevus)
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Defn:
1) flat, round, pigmented choroidal lesion 2) rarely causes any visual disturbance 3) raised lesions are likely malignant |
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Malignant choroidal melanoma
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Defn:
1) a pigmented, raised lesion of the choroid Pres: 1) retinal detachment 2) vitreous hemorrhage 3) secondary glaucoma Tx: 1) enucleation of the eye 2) irradiation 3) photocoagulation 4) surgical excision |
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Choroidal metastasis
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Pres:
1) flat, multiple deposits at the posterior pole 2) assoc with exudative retinal detachment Tx: 1) radiotherapy |
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Central retinal artery occlusion
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NH:
1) sudden visual loss in one eye 2) blindness in that eye within minutes Findings: 1) constricted retinal arteries (threadlike) 2) milky white fundus (retinal edema) 3) cherry-red spot on macula 4) optic atrophy after a few weeks |
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Predisposing factors for central retinal vein occlusion
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1) HTN
2) DM 3) Arteriosclerosis 4) Open-angle glaucoma 5) Hypercoagulable state |
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Findings in Central Retinal Vein Occlusion
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1) Tortuous engorged vessels
2) untilateral disc edema 3) hemorrhages + soft exudates |
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CRVO prognosis
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Bad for elderly, moderate for younger people
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Rubeosis iridis
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development of new vessels on iris
1) due to ischemia of retina 2) can cause secondary glaucoma (thrombotic) |
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Findings in Brach Retinal Vein Occlusion
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1) fan-shaped distribution of retinal flame-shaped hemorrhages radiating from arteriovenous crossings
2) macular edema |
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Predisposing factors for Branch Retinal Vein Occlusion
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1) HTN
2) Arteriosclerosis 3) DM |
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Retinal Detachment
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Separation of the retinal neurosensory layer from the RPE
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Regmatogenous
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Involving a break
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Degenerate retina has what characteristic?
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It is thin
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Sx of retinal tear
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1) many floaters -- recen onset
2) flashes of light |
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Dx of retinal detachment
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1) Dilate
2) View with indirect ophthalmoscope --> better view of peripheral retinal than direct |
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Tx for retinal tears
|
Make an adhesive scar with:
1) Photocoagulation 2) cryoapplication Push back with: 1) silicone 2) drainage of SRF 3) gas injection and vitrectomy |
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Exudattive Retinal Detachment causes
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1) malignant choroidal melanoma
2) severe uveitis 3) toxemia of pregnancy |
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Traction retinal detachment causes
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Fibrous detachment:
1) proliferative diabetic retinopathy 2) penetrating injury 3) ROP |
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Juvenile macular dystrophy
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1) Bilateral
2) Symmetric 3) gradual progression 4) painless 5) visual loss |
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AMD findings
|
1) Pigmentary clumps
2) Patches of atrophy 3) Drusen (colloid bodies) -- under RPE |
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Will a patient go completely blind due to AMD?
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No, peripheral vision should be preserved
|
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Central serous retinopathy: how?
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fluid from choroidal capillaries --> through RPE --> accum under macula --> self-limiting, benign
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Degenerative myopia
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1) familial
2) proe pronouced chorioretinal atrophy at posterior pole, surounding disc 2) increased axial lenght of eye 3) Cmplx: ret. det. 4) No treatment |
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Retinitis Pigmentosa
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All types of inheritance
NH: 1) poor dim light vision 2) Progressive loss of peripheral visual field 3) 1st - 2nd decade 4) blindness by 5th to 6th decade Findings: 1) retinal pigment proliferation - brown, spider-like 2) waxy-yellow disc 3) attenuate retinal vessels |
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Types of vitreal degeneration
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1) synchisis scinillans -- posterior vitreous detachment
2) white deposits 3) asteroid bodies |
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Common systemic conditions affecting the eye
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1) DM
2) HTN 3) thyroid dz 4) RA 5) Vit A deficiency 6) onchocerciasis |
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DM changes
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1) decreased visual acuity
2) EOM paralysis (CN 3 or 6) 3) Rubeosis iridis 4) sluggish pupillary constriction/dilation 5) senile cataract |
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Classifications of Diabetic retinopathy
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1) background DR
2) proliferative DR |
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Background diabetic retinopathy
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1) retinal microaneurysms
2) round dot hemorrhages 3) hard exudates - yellow |
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Pre-proliferative diabetic retinopathy
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Vascular obstructive changes
1) soft exudates -- cotton wool spots 2) large blot hemorrhages 3) dilated/segmented veins, venous loops --> ischemic retinal damage, loss of capillar circulation |
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Percent of patients with diabetic retinopathy that progress to proliferative DR
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10%
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Definition of Proliferative DR
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Neovascularization on retinal surface and at optic disc
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Cmplx of Proliferative Diabetic retinopathy
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1) Vitreous hemorrhage
2) Fibrous tissue formation --> traction ret. det. |
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Tx for prolif DR
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1) laser photocoag
2) regular fundus exams with dilation 3) fluorescein angiography |
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Effects of HTN on arterioles in young, older
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Young: arteriolar constriction
Middle age: thickening, sclerosis 1) widening of light reflex 2) copper/silver wiring 3) arteriovenoius nipping 4) potentially: BRVO |
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Findings in HTN
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1) thickening
2) copper/silver wiring 3) AV nipping 4) flame hemorrhages 5) soft exudates (cotton wool spots) |
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Keith-Wagner classification of hypertensive retinopathy
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1) thickening
2) AV nipping 3) flame hem 4) papilledema, hard exudates all indicate vessel state elsewhere |
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Pre-eclamptic HTN
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1) HTN changes
2) bilateral exudative inferior retinal detachment |
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Severe anemia findings
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1) flare hem
2) soft exudates |
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Hyperviscosity (e.g. polycythemia vera) findings
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1) retinal hem
2) soft exudates 3) edema 4) looks simlar to CRVO |
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Sickle cell
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1) fibrovascular proliferation
2) localized chorioretinal scars 3) vitreious hemorrhage 4) traction ret det |
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Peripheral retinal vasculitis + vitreous hemorrhage (Eales' dz)
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1) recurrent vitreous hem
2) abnormal peripheral ret. veins |
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Hyperthyroidism
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1) lid retraction
2) lid lag 3) exophthalmos 4) poor convergence 5) infrequent blinking |
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Causes of Thyroid exophthalmos
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1) orbital edema
2) lyphocyte infiltration |
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Thyroid exophthalmos findings
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1) Inability to elevate eyes
2) difficulty closing the eyelids (lagophthalmos) --> exposure keratitis |
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AIDS findings
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1) cotton-wool spots
2) neoplasms (e.g. Kaposi's sarcoma) of eyelid, conjunctiva, orbit 3) neuro-op lesions 4) CMV retinits (cheese piza -- white lsions + hemorrhage) 5) T. gondii, HSV, HZO, candida, PCP |
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Vit A def
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Keratomalacia
1) drying of conj (xerosis) 2) corneal ulcer, peforation |
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Onchocerciasis (river blindness)
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1) jinja fly bite --> microfilariae
Cmplx 1) irits 2) secondary claucoma 3) cataract 4) vitreoretinal damage |
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Leprosy
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1) affects eye in 30% of cases
2) CN VII paralysis -- OO, leads to ectropion, lagophtalmos 3) Keratitis 4) Madarosis (loss of eyebrows/lashes) 5) Anterior uveitis |
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Syphilis
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1) Can affect eye at any stage
2) uveitis 3) congenital syphilis $) bilateral interstiial keratitis 5) chorioretinal scars |
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RA
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1) Dry eyes
2) Episcleritis --> scleromalacia 3) Chloroquine --> maculopathy + corneal deposits 4) steroid therapy --> cataracts |
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Acne rosacea
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1) chronic conjunctivits
2) blepharitis 3) severe superficial keratitis + cornea neovascularization 4) Tx w/ steroids |
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Stevens Johnson syndrome
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1) severe conjunctivitis
2) corneal scarring |
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Causes of Unilateral proptosis
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1) mucocele of the sinus
2) infiltration of orbit by nasopharyngeal carcinoma |
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Disc swelling findings
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1) blurring of disc margin
2) swelling of optic nerve head 3) "filling in" of cup 4) venous pulsations absent 5) veins dilated 6) small hemorrhages around disc 7) edema |
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Papilledema vs. Papillitis
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Papilledema
1) passive disc swelling due to increased ICP 2) bilateral 3) normal vision Papillitis 1) inflammation of optic nerve 2) unilateral 3) visual loss (usually with central scotoma) 4) dilated, unreactive pupil |
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Retrobulbar neuritis
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1) pain on eye movmenet
23) usdden blurred vision 3) defective color vision 4) central scotoma Tx: steroids |
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Causes of optic atrophy
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1) optic neuritis
2) meningitis 3) encephalitis 4) CRAO 5) ischemia of optic nerve 6) Retinitis pigmentosa 7) glaucoma 8) vit B def 9 syphilis |
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Chiasmal lesion
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1) bitemporal hemianopsia
2) causes 1) pituitary adenoma (chromophobe) 2) suprasellar cyst (craniopharyngioma) |
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Causes of large pupil
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1) mydriatic drugs
2) optic neuritis 3) CN III paralysis 4) optic atrophy 5) trauma to sphincter 6) retinal dz 7) Adie's tonic pupil |
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Causes of small pupil
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1) Miotic drugs (e.g. pilocarpine, morphine)
2) iritis 3) syphilis 4) Horner's syndrome |
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Irregular pupil
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1) Congenital iris defect
2) posterior synechiae 3)syphilis $) surgery |
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Marcus Gunn pupil
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Afferent pupillary defect
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Argyll Roertson pupil
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accommodates but doesn't react
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3rd nerve palsy
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1) ptosis
2) down (SO) and out eye (lat. rectus) 3) dilated pupil |
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6th nerve palsy
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convergent squint
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4th nerve palsy
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1) elevated when adducted (due to IO)
2) compensatory head tilt |
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Causes of EOM paralysis
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1) Trauma
2) DM 3) Arteriosclerosis 4) Aneurysms |
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EOM paralysis: Separation of image side by side or above one another?
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1) Side by Side -- 6th nerve
2) Above -- 3rd or 4th nerve |
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EOM paralysis: Direction of maximum gaze separation?
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Direction of action of affected muscle
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EOM paralysis: Which eye gives fainter image?
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The one with the paralyzed EOM
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Myasthenia gravis
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1) diplopia
2) bilateral ptosis |
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Nystagmus defn
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Involuntary oscillatory movement of eyes
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Nystagmus types
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1) Jerk (cerebelloum or vestibular problem)
a) slow component b) fast component 2) Pendular (ocular) nystagmus a) no slow or fast component b) caused by poor vision, inability to fixate |
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Common injuries
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1) chemicals
2) flying particles 3) sharp instrument 4) blunt injury 5) w/ head injury 6) welding burns |
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Chemical injury tx
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dilute chemical ASAP
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Alkali burn cmplx
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Can penetrate eye
1) corneal damage 2) cataract 3) iridocyclitis 4) glaucoma |
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Why are acids somewhat less dangerous than alkalis?
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They coagulate collagen --> forma a barrier to eye petnetration --> less damage to internal structures
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Corneal foreign body sx
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1) photophobia
2) congestion 3) irritation --> remove w/ blunt instrument to decrease risk of perforation |
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Penetrating would cmplx
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1) damage to cornea or lens
2) intgraocular hemorrhage 3) retinal damage 4) prolapsed iris |
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Blunt injury cmplx
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1) hyphema (blood in anterior chamber) due to torn BV in iris
2) damage to pupillary sphincter 3) secondary glaucoma 4) blood-stained cornea 5) lens dislocation 6) vitreous hem 7) ret det |
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Blowout fracture
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1) usually floor of orbit --> IR, IO affected
2) diplopia 3) limited eye movement |
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Welding burns
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due to intense UV light
Sx: 1) Photophobia 2) blehparospasm 3)pain 4) watering Tx: 1) patching 2) analgesics |
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Myopia types (2)
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1) physiologic
2) pathologic --> degenerative changes of retina, macula in partiuclar |
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Hypermetropia
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Far-sightedness, image behind the retina
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Astigmatism
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1) Cornea or lens is not spherical --> has greater power in one meridian
2) corrected with cylindrical lens 3) pathological causes: a) corneal scarring b) keratoconus |
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Presbyopia
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weak accommodation (usually with age)
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Cmplx/sx of contact lens wear
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Sx:
1) pain 2) watering 3) photophobia 4) eyelid spasm Cmplx: 1) corneal edema |
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LASIK
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Laser-Assisted Intrastromal Keratomileusis
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Aphakia
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Eye without lens (usually after cataract extraction)
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DDx for white pupil (leukocoria)
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1) Retinoblastoma
2) ROP 3) Congenital cataracts 4) Persistent primary hyperplastic vitreous 5) Coats' dz -- exudates from abnormal retinal vessels 6) Endophthalmitis 7) Organized vitreous hemorrage |
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Retinoblastom
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1) Most common intraocular malignancy
2) white pupil (leukocoria) 3) high malignancy Tx/Mgmt 1) Chemo 2) Radiotherpay 3) Photocoagulation 4) cryoapplication 5) enucleaiton |
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ROP
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1) more common in babies who receive O2
Tx: 1) Photocoag 2 Cryotherapy 3) vitreous surgery |
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Types of strabismus/squints
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1) Paralytic
2) Non-paralytic |
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Effects of suqints in children
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1) amblyopia (lazy eye)
2) Failure to develop binocular single vision 3) cosmetic blemish -->< emotional, socioeconomic problems |
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Convergent squint = esotropia
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1) assoc. w/ hypermetropia
Tx: glasses for farsightedness |
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Divergent squint
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1) usually develops in kids > 3 y.o.
2) Assoc w/ myopia |
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Causes of Amblyopia
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1) ptosis
2) corenal scar 3) cataract 4) contgential nystagmus |
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Causes of Infective conjunctivitis in kids
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1) gonorrhea
2) staph 3) strep 4) hemophilus 5) pneumococus 6) HSV 7) chlamydia Tx: Abx |
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Tx of late canalization of nasolacrimal duct
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1) astringent eyedrops
2) massage of lacrimal sac |
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Congenital cataracts
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1) do surgery in first 6 months --> prevent amblyopia
2) Lens can be aspirated b/c nucleus is soft in kids |
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Congenital Glaucoma
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1) buphthalmos (ox eye -- increase in corneal, eye size)
2) Tears in Descemet's membrane --> corneal edema, irritation, watering, photophobia Pres: 1) photophobia 2) tearing 3) large opaque cornea |
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Neurofibromatosis
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Neurofibromas in
1) eyelids 2) orbit 3) retina Optic nerve gliomas |
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Tuberous sclerosis
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1) retina or optic disc has yellowish raised nodule that looks like a mulberry
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Sturge-Weber
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1) capillary hemangioma (choroidal)
2) congenital glaucoma |
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von Hippel-Lindau
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Hemangioma
1) retinal exudates 2) hemorrhages 3) ret det Tx: photocoag, cryotherapy |
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Cuase of coloboma of iris or choroid
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Incomplete closure of choroidal fissure
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Lid defects
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1) ptosis
2) coloboma of lid (Kleinfelter's) 3) obstruction of lacrimal apparatus |
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Lens defencts
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1) Marfan's
2) Homocystinuria |
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Optic disc defects
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1) Optic pits
2) Hypoplasia of optic nerve |
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Antenatal infections
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1) Toxoplasmosis
2) Rubella 3) Syphilis (ToRcheS) |
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Congenital rubella
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1) congenital cataract
2) nystagmus 3) pigmentary changes in retina |
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Congenital Toxoplasmosis
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1) chorioretinal scar at macula
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