N: Eye Dz

Front 1

Define Myopia, Hyperopia, Presbyopia, Astigmatism.

Back 1

- myopia: eye is longer than normal or the cornea and lens focus too strongly --> image falls in front of retina
- Hyperopia: too short or lens/cornea too weak --> image behind the retina
- Presbyopia: lens gets more rigid as we age, can't change shape as easily
- Astigmatism: different corneal or lens curvatures (per axis) --> causes multiple focal points.

Front 2

1) Chronic inflammation of the eyelid margin is called...
2) clogged meibomian glands (meibomitis) is tx'ed w/...
3) What is another term for acute hordeola?
- two types?
4) What do we call a meibomian gland cyst?
- painful?
- rupture may cause what?

Back 2

1) Blepharitis
2) hot compresses and PO doxycycline
3) Stye (staph abscess)
- internal (meibomian gland)
- external (lash follicle)
4) Chalazion
- no
- granuloma

Front 3

List and briefly characterize (agent) the 3 causes of conjuctivitis.

Back 3

1) Viral: adenovirus --> highly contagious. BILATERAL. preauricular nodes. URI/ST/Fvr common in 1wk hx. Tx = cool compress/chilled tears. Refer if photophobic, painful, \viz.
2) Staph, strep, Haemophilus. topical antiB drops QID 4d. Warm compress. Refer if not markedly better in 4d.
3) allergies: itching, edema, watery. Tx = topical antiH. refer refractory cases.

Front 4

Foreign body sensation, pain, tearing, and photophobia are all sx of what?
- eval?
- tx? What should NEVER be used?

Back 4

Corneal abraisons
- look under upper lid for foreign body; stain with fuorescein (abrasion appears green)
- topical antiB as prophylaxis, topical cycloplegic, tape eyelid closed.
- NEVER use topical anesthetics.

Front 5

What is a subconjunctival hemorrhage?
- tx?

Back 5

a usually aSx or min. irritating hemorrage that can be caused by eye rubbing, valsalva, trauma, HTN, bleeding disorder, or just be idiopathic.
- check BP meds if on 'em; artificial tears and reassurance (usually clears in 2wks)

Front 6

Severe compression of the left or right optic nerves results in what?

Compression of optic chiasm (as in pituitary tumor)?

optic tracts?

How do you get macular sparing?

How do you get a quandrantopia?

Back 6

ipsilateral blindness.

loss of temporal vz fields.

homonymous hemianopia of opposite viz field

lesions of the calcarine bank of the cortex.

Damage to Meyer's loop or the radiations; viz field flips upside down tho, so remember that.

Front 7

What is amblyopia?
- curable?

Strabismus?

Back 7

loss of viz acuity NOT correctable by glasses
- only if caught early on.

misalignment of the two eyes causing double viz in adults. Can lead to amblyopia in kids under 10.

Front 8

Describe 3rd nerve palsy.

4th nerve palsy. Movement to detect it in patients?

6th nerve palsy.

Lateral gaze palsy (also give two possible locations that would cause this).

Back 8

Eye is rotated down and out. Ptosis. Pupil dilation.

hypertropia (striabimus w/ affect eye pointing higher) and extorsion of the affected eye.
- head tilt and chin tuck (tilt away from affected eye corrects exotorsion; tuck [looking slightly upward] corrects hypertropia)

Affected side can't abduct.

BOTH eyes can't gaze to the side of the lesioned abducen's nucleus/PPRF.

Front 9

Lesion of the MLF would cause what?

What is one and a half syndrome?

Back 9

intranuclear nuclear ophthalmoplegia: when directed to look AWAY from affected side, the ipsilateral eye cannot move, and the contralateral eye shows nystagmus.

Lesion of MLF and abducen's nucleus on same side.
- eyes cannot look to the side of the affected abducens. Only the contraleral eye can move looking the other direction, but it shows nystagmus when it does.

Front 10

Unbalanced pupil size best seen in the dark is likely due to what? Best seen in the light?

Back 10

Dark: sympathetic defect (cannot dilate)
Light: parasymp. defect (cannot constrict)

Front 11

A pt with an afferent pupillary defect would show what?
- what is used to pick this up?

occulomotor nerve lesion?

Back 11

no constriction of any sort when light is shone in affected eye.
- swinging flashlight test

Only consensual contriction when light is shone in affected eye.

Front 12

An lesion of the descending sympathetic fibers in the brainstem/spinal cord will cause...

Back 12

...ipsilateral Horner's.

Front 13

Define Papilledema

What are teh top 6 serious eye dz?

Back 13

optic disc swelling that is caused by ^ICP

God Damn Cats Totally Hate Me

Glaucoma, Diabetic retinopathy, cataracts, trachoma, HTN retinopaty, macular degeneration.

Front 14

1) What is the etiology of glaucoma?
2) Differentiate between Open angle glaucoma and closed angle (acute).
3) Leading cause of irreversible viz loss in AA i/ US?

Back 14

1) ^Intraocular Pressure (IOP)
2) open: trabecular mesh drainage network is blocked; closed: angle formed by cornea and iris narrows causing rapid ^IOP.
3) Glaucoma

Front 15

Pt present reporting severe ocular pain, frontal HA, Blurred viz w/ halos, N&V; on PE they have conjunctival hyperemia, a cloudy cornea, and mid-dilated/irregular pupil. Top of the Diff?

Tx of either type of this dz?

Back 15

Acute, Angle Closure Glaucoma.

DROPS:
- Prostaglandin eye drops (1xday): allow better aqueous outflow.
- B-blockers: decrease aq. production
- a-agonists: decrease aq. production; can be used in conjunction w/ other drops.
- parasympathomimetics: increase aq outflow.
- Epinephrine: ^ outflow, \production

PILLS:
- Carbonic anhydrase inhib: \aq production.

Front 16

An increase in pupil block is associated with which dz?

Back 16

acute, angle closure glaucoma.

Front 17

Aging, Diabetes, Family hx, previous inj/surg, and prolonged steroid use are all causes of this leading source of viz loss worldwide. Is it reversible?

Back 17

Cararacts; REVERSIBLE.

Front 18

What is the most common cause of IRREVERSIBLE visual loss over the age of 65? Characterize this dz.
- two types? Which is more common? Prevention/slow progression tx?

Back 18

Macular tiss degenerates (Age-related Macular degeneration) --> mild/severe loss of central viz. NOT total blindness.
- dry and wet
- dry is more common.
- dietary supplements of C, E, Zinc, Copper Oxide, and beta-carotine (have pts look for AREDS study vitamins)

Front 19

What is the leading cause of blindness in the US in those UNDER 65y?
- pathogenesis?
- % tx-able?
- tx? viz loss w/ tx?

Back 19

Diabetic retinopathy (ch. i/ retina from diabetes)
- new blood vessels are forming b/c of the diabetes, which then aneurysm/hemorrhage
- 90% of diabetic changes are tx'able if cause early.
- panretinal laser tx: laser puts hundreds of tiny light burns in retina --> \angiogenesis.
- only lose some peripheral viz.

Front 20

Arteriolar narrowing (almost always bilateral); Flame-shaped hemorrhages; "cotton wool spots" from ischemic change; edema, "AV nicking"; "macular star" = ring of exudate around retina...
.. all these changes to the retina can be a result of what?

Back 20

HTN --> Hypertensive retinopathy

Front 21

What is Trachoma?
- result if untx'ed?
- Best way to prevent transmission from infected children?
- tx in early stages? Later?
- prevention?

Back 21

result of infection of the eye w/ Chlamydia trachomatis.
- irreversible blindness
- washing hands and face.
- antiB; after scarring begins, surg to reverse inward turned eyelashes.
- proper diet, sanitation, education.

Front 22

How do we tx Neonatal Chlamydial Conjunctivits?
- sx? how long does it develop post-birth?
- what do we do with all infants since this is so common?

Back 22

SYSTEMICALLY to prevent pneumonia.
- swollen eyelids, conjunctival inflammation, yellow, purulent discharge.
- few days to several weeks.
- prophylaxis erythromycin eye drops.

Front 23

Pt presents with acute onset of painless, monocular viz loss. On PE, you see retinal edema, and a cherry red spot. What is this spot? What is usually the etiology of this dz? Is this an emergency?

Back 23

Central Retinal Artery Occlusion.
- spot is due to lack of nerve fiver layer in fovea (chorioid is not covered w/ infarcted nerve in this spot)
- thromboembolic phenomena
- TRUE EMERGENCY: try to \IOP w/ timolol, mannitol, ocular massage, and anterior chamger paracentesis. MOST do not regain useful viz.

Front 24

Pt presents with acute or subacute onset of painless, monocular viz loss. On PE you note macular edema and neovascularization. What might you think this is?
- common cause?
- medical tx?

Back 24

Central retinal vein occlusion (CRVO)
- thrombosis of a portion of the venous circulation that drains the retina.
- none known effective for tx or prevention.

Front 25

Differentiate arteritic and non-arteritic cases of Anterior Ischemic optic Neuropathy (AION).
- cause of either?
- tx of arteritic group?

Back 25

arteritic: those associated w/ temporal arteritis
- stroke in the distribution of short posterior ciliary arteries which spuply the optic nerve head, usually 2ndary to arteriolarsclerosis.
- steroids.

Front 26

What is Optic Neuritis?
- pts with 1st time acute onset are usually what?
- must eval for which dz?
- Rx w/ what?
- do most pts have a swollen optic disc at presentation?

Back 26

demyelinating inflammation of the optic nerve: acute monocular viz loss (partial or complete) or sudden blurry or foggy viz and mild pain on movement of the affected eye.
- otherwise healthy young adults
- MS
- intravenous steroids - most will recover some viz
- only 1/3rd do.

Front 27

Which dz, constituting 3% of all childhood cancers, is the reason why we check a red reflex?
- 45% are heritible, which crm and which gene?

Back 27

- crm13, RB1 gene.

Front 28

Peaked pupil, Hyphema, Vitreous hemorrhage, Uveal Prolapse, Bullous subconjunctival hemorrage.... what are these indications of?
- what do we do?

Back 28

open globe trauma
- urgent ophthalmological consultation is needed.