Em - Ophthalmalogic Non-Trauma Emergencies

Front 1

Common causes of pharmacologically-blocked mydriatic eye (fails to respond to topical pilocarpine):

Back 1

- aerosolized albuterol / ipratropium

- scopolamine patch

- phenylephrine drops

Front 2

perlimbic flush - DDx?

Back 2

glaucoma

iritis

Front 3

Patient has L eye pain. Shining light into R eye WORSENS the pain. - DDx?

Back 3

- iritis (b/c consensual movement of inflamed iris)

- ciliary spasm

Front 4

red sclera + preauricular LAD - Dx?

Back 4

adenovirus conjunctivitis

Front 5

red sclera + lesion and pain on tip of nose - Dx?

Back 5

"Hutchinson's sign"

herpes zoster ophthalmicus (nasociliary branch of V1)

Front 6

hypopyon

= ?

causes?

Back 6

= pus in anterior chamber (perilimbic, dependent)

seen in endophthalmitis

2/2:
- corneal ulcer
- hematogenous spread
- bacterial conjunctivits with penetrating organism (GONOCOCCUS, Listeria, Corynebacterium, H. aegyptius)

Front 7

periorbital (preseptal) cellulitis - most common cause?

Back 7

hematogenous spread

Front 8

orbital cellulitis = most common cause

Back 8

direct spread from ethmoid sinus

Front 9

Pregnant woman presents with fever, headache, ophthalmoplegia.

Dx?

Best test?

Back 9

cavernous sinus thrombosis

MRI/MRV

Front 10

Patient with unilateral OR bilateral eye pain, perilimbic injection, miotic pupil(s)

Dx?

Best test?

Back 10

IRITIS (don't jump to conjunctivitis!)

Slit lamp exam of anterior chamber (cells, flare, keratotic precipitates on back of cornea)

Front 11

Iritis - Tx?

Back 11

ORAL ABx (NOT topical!)

Topical cyclopegic (NOT just a mydriatic, MUST also paralyze accommodation); goal =prevent posterior synechiae

+/- steroids

Front 12

pinguecula

Back 12

conjunctival fibrovascular tissue

LIMITED to sclera

Front 13

pterygium

Back 13

conjunctival fibrovascular tissue

OVER CORNEA

Front 14

Rx - cycloplegics (short-acting)

Back 14

tropicamide

homatropine

** NEVER USE atropine... lasts 1-3 WEEKS! **

Front 15

APD (Marcus Gunn pupil) - DDx?

Back 15

- central retinal artery occlusion

- central retinal vein occlusion

- optic neuritis

- retrobulbar neuritis

Front 16

Anisocoria - DDx?

Back 16

- Horner's

- CN III palsy

- Argyll-Robertson pupil

- Rx-induced

- Adie's pupil

Front 17

Light-near dissociation - DDx?

Back 17

- Argyll-Robertson pupil

- Adie's pupil

Front 18

Miotic, irregular pupil. Accomodation intact. Fails to constrict to light.

Dx?

Causes?

Back 18

Argyll-Robertson pupil

DIABETES!!!
3' Syphilis

Front 19

Adie's pupil.

Causes?

Back 19

#1 = idiopathic, parasympathetic denervation in ciliary ganglion

herpes zoster opththalmicus

Front 20

Pupil reacts to light but fails to accommodate.

Back 20

IMPOSSIBLE.

Front 21

Sudden, PAINLESS, monocular vision loss.

DDx?

Back 21

- central retinal artery occlusion
- central retinal vein occlusion
- vitreous hemorrhage
- retinal detachment

Front 22

63yo M with CAD. Sudden, PAINLESS, monocular vision loss.

Dilated, non-reactive pupil. +APD.

Pale retina with cherry-red spot macula (choroidal aa.)

Back 22

embolic occlusion of central retinal artery

Front 23

Sudden, PAINLESS, monocular vision loss.

Dilated, non-reactive pupil. +APD.

Multiple large hemorrhages on fundus ("blood and thunder")

Back 23

central retinal vein occlusion

Front 24

68yo F with T2DM. Sudden, PAINLESS, monocular vision loss.

Dark floating spots.

No red reflex. Decreased retinal details.

- Dx? Test?

Back 24

vitreous hemorrhage

ocular u/s

Front 25

Earliest sign of papilledema?

Back 25

Loss of spontaneous venous pulsations

(may be elicited with ipsilateral jugular v. compression)