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157 Cards in this Set
- Front
- Back
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retina: Grey white discoloration, no damage to surrounding blood vessels
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Commotio Retinae
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DDX Orbital cellulitis from Preseptal
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Orbital has proptosis, fever, pain on EOM/restrictions
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Palsy associated with CCF
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CN 6
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4 signs of an ocular tumor
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1. progressive proptosis
2. APD 3. Diplopia 4. progressive vision loss |
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2 malignant tumors in kids
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primary: rhabdmyosarcoma
Secondary: nueroblastoma |
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triad for primary orbital meningiomas
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1. vision loss
2. optic atrophy 3. optociliary shunt vessels |
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older patients with proptosis
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Lymphoma
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optic nerve glioma, lish nodules, cafe au-leil spots
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nuerofibromatosis type 1
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ddx graves from orbital pseudotumor
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Orbital pseudotumor is painful, sudden, proptosis and EOM restriction
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What nerves are NOT in the cavernous sinus
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CN V3: (mastication and jaw sensation),
CN 7: face motor, lacrimation, taste, dampens sound |
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Tosola-hunt affects what?
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Cave Sinus
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Weakened orbital septum, causing fat protrusion causes...
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Dermatochalasis
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Benign Essential blepharospasm + jaw abnormalities =
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Miege's syndrome
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Myokemia is
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unilateral orbicularis oculi twitches
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Gelatinous neo-vascularized mass at the limbus
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Conjunctival intraepithelial neoplasia (CIN)
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Bacterial conjuctivitis is worse in the...
Cause is kids? Cause in adults? |
...Morning
Kids: H. influenza Adults: Staph epidermidis and aureus |
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Gonoccocal conj'itis presents with:
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1. Hyperacute onset
2. Severe mucopurulent discharge 3. Psuedomembranes* 4. Pre-auricular* |
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EKC serotypes?
PCF serotypes? |
EKC: 8,19
PCF: 3, 7 |
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DDX EKC and PCF
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EKC: pain, corneal invovlment, SEI
PCF: follicles, fever, pharyngitis |
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dome shaped waxy nodules
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Molluscum contagiosum (think HIV or immunocomprimised)
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Herpes simplex conjuctivitis signs
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unilateral follicular conjunctivitis, watery discharge
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Follicles: (Firm dx of?)
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Chlamydia
Toxic Viral |
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Superior papillae,
Inferior papillae common in what allergic conjuctivitis? |
Sup: VKC, GPC
Inf: AKC |
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Chronic inf follicles, pre-auricular sweeling
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Chlamydial conj'itis
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Serotypes for chlam inclusion and trachoma?
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Inclusion: D-K
Tr A-C homa: A-C |
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Arlt line
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white scar of sup tarsal conj (trachoma)
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Herberts pits
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Depressions of limbal conj after resolution of limbal follicles (trachoma)
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Positive TB test values
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15, 10, 5mm
Healthy, exposed, HIV |
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Woody plaque of sup tarsal conj
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Ligneous conj'itis
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What bothers Bowmans membrane?
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1, Pterygium
2. KC 3. reis buckler |
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Worst form of scleritis?
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Necrotizing WITH inflammation
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Main 3 symptoms of Ant Uveitis
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1. Pain
2. redness 3. Photophobia |
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3 threats to vision in Ant Uveitis
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1. PS (synechiae)
2. PAS 3. CME |
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Acute Non granulomatous Ant Uveitis Causes
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1. Idiopathic
2. Ankylosing spondlytis 3. Reactive arthritis 4. IBD Bechets, Lyme, Glaucomatocyclitic crisis |
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Chronic granulomatous Ant Uveitis causes
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1. Sarcoid - chest xray, ACE
2. TB - Chest xray, PPD, Night sweats 3. Herpes - inc IOP 4. Syphilis - VDRL, RPR, FTA-ABS |
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Chronic non granulomatous ant uveitis causes
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1. JRA - ANA
2. Fuch;s heterochromic iridocyclitis- Very Mild Uveitis |
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Meds that cause anterior uveitis (3)
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Sulfonamides, Cidofovir, Rifabutin
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Causes of Post Uveitis
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1. ToxoP - parasite from cat feces
2. Histo - Fungus from chickens 3. Sarcoid - snowbank, candle wax 4. syphilis- S y P 5. Pars Planitis - snowbank 6. CMV- bloody vitreous |
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Vitritis in CMV vs Toxo vs PORN
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CMV: blood
Toxo: cells PORN: min blood and cells |
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normal cornea sizes
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avg: 11.7
Bt 10-13mm |
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Corneal appearance is worse than symptoms indicate
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Neurotrophic keratopathy
(CN V, VII, diabetes, Herpes) |
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Rule of 10s
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< 10 mm is abnl for Schirmers (anesthetized), PRT, and TBUT (seconds)
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Moderate KC keratometry readings
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48-54
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Fleischers ring
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KC iron ring around base of cone
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Hudson Stahli line
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Horizontal line in cornea from age
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Ferry's line
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Line at edge of filtering bleb
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Kayser Fleischer Ring
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Copper accumulation from wilsons dz
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AR ectasia assoc w/ ehlers danlos, blue sclera, and Leber's
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Keratoglobus
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All corneal dystrophies are AD except for these 2
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Macular dystrophy (AR)
Megalocornea (X) |
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the 3 "epithelial" corneal dystrophies
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EBMD
Meesman's- multitude of intra epi cysts Reis Buckler- fishing net in bowmans |
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Stromal Corneal Dystrophies
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Marylin Munro Got High in LA w/Schnyder who has high cholesterol...
Macular: Mucopolysaccharide Granular: Hyaline Lattice: Amyloid Schnyder: cholesterol crystal |
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Most likely stromal corneal dystrophy to get RCEs?
The epithelium says "Let Me Go!" |
Lattice! > Macular > Granular
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Normal endothelial cell count @ age 40? 70?
(cells/mm^2) |
40: 3k
70: 2k Corneal edema @ <500 cells/mm^2 |
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When is Fuch's pain worse?
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in the morning
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Ddx Fuchs vs Post Polymorphous dystrophy via age of onset
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Fuch's is later in life than post polymorphous dystrophy
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Thickening of Descemet's cause endothelium pumps to function poorly, leading to this dystrophy.
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Fuchs!
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Where do thiazide diuretics work?
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Early distal convoluted tube. Work on Na Cal pump
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Light absorption in a photoreceptor causes what chemical change?
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11-cis-retinal to all-trans-retinal
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cause of bitemporal hemianopsia?
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Pituatary gland tumor
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Bell's palsy causes what? Etiology?
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Paralysis of half the face.
From a lesion to a LOWER motor nueron in CN 7. |
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Parallel horizontal cracks in descemet's from cong'l glaucoma
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Haabs Striae
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Anteriorly Displaced Shwalbe's line
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Posterior embryotoxin
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Displaced Shwalbe's line + Iris Strands
(+ glaucoma) |
Axenfeld's anomaly (Syndrome)
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Displaced Shwalbe's line + iris strands + Displaced pupil and iris atrophy
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Rieger's anomaly
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Rieger's syndrome includes
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Reiger's anomoly + mental retardation and facial.dental abnormalities
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Central corneal opacity + iris adhesions
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Peter's anomaly
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% of pts who develop glaucoma in Axenfeld's, Reigers, and Peter's anomaly
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50% develop glaucoma
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Aniridia may keep company with...
Cornea: Lens: Posterior seg: |
Cornea: opacity, micro, pannus
Lens: cataract, sublux Post: hypoplasia of fovea or disc, GLAUCOMA (75%), choroidal colobomas |
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The top 5 bugs that cause bacterial keratitis
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Psuedomonas
Staph Epi and Aureus H. Flu Moraxella catarrhalis |
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Thick mucupurulent discharge, oftern greenish, hypopyon bacterial keratitis is caused by what bug?
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Psuedomonas
Also associated with CL wear |
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Psuedomonas can perforate the cornea within {blank} time. But it requires an epithelial defect
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48 hours
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White feathery edged lesion with satallite lesions
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Aspergillus or Fusarium fungal keratitis.
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Fungal keratitis agent that looks like bacterial keratitis
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Candida
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Which fungi invades immunocompromised eyes? Which fungi is commonly from vegi matter trauma?
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immunocompromised: Candida
Vegi: aspergillus and fusarium |
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Patchy stromal infiltrates in cornea, eventually forming a ring is caused by?
Hint: may have psuedodendritic epithelial defects |
Acanthomoeba! Dont let the psuedodendrites fool you!
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What can herpes simplex cause on/in the eye?
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Cornea: Epithelial keratitis, Disciform keratitis, Interstitial keratitis
Conj: blepharoconjunctivitis |
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What do you do with stromal edema from herpes? What is it caused by?
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Corneal specialist + steroids + viroptic due to possible scarring. Caused by water into descemet's, AKA Endothelitis
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HZV in patients younger than 40
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Probably immunocompromised
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Which nerve is responsible for hutchinson's sign in HZV?
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Nasociliary n of CN V
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describe Interstitial Keratitis
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Stromal inflammation without corneal epithelium or endothelium involvment
Causes: Syphillis, Herpes, TB |
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Describe the early, middle, and late stages of mooren's ulcers
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Early: gray infiltrate (Peripheral)
Middle: stromal thinning + epithelial defect Late: Ulceration spreads 360 degrees |
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Staphlococcal marginal keratitis
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Peripheral infiltrates assocaited with pylectenules. A hypersensitivity rxn to staph aureus
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Peripheral corneal thinning/ulcers can be caused by these collegen vascular ds
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RA, SLE, Polyarteritis nodosa, Wegener Granulomatosis
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Terriens marginal ds is most common in what gender/
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Men >40 years
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DDX terriens from Moorens ulcer
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Terrien's will not have an overlying epithelial defect over the thinning peripheral cornea.
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Salzmann's pts are typically what gender?
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Females
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Salzman's blue grey nodules are normally assoc with what?
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Old scar, dry eye, chronic corneal keratitis
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Circumlimbal opacities beginning nasally (from age)
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White limbal girdle of Vogt
ddx from terrien's: Terriens begins superiorly and it's thinning of periphery |
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Systemic dz assoc with band keratopathy
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Gout and Hypercalcemia
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Bilateral flour dust on deep stroma
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corneal farinata
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Refractive surgery that Ablates epithelium and Bowmans layer
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PRK
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potential PRK Side effects
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regression, steroid induced glaucoma, corneal haze
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Potential side effects of RK
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hyperopic shift, perforation, diurnal fluctuation
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Which cataract causes a myopic shift?
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Nuclear sclerotic cataract
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Which cataract causes a hyperopic shift?
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Cortical cataract
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What can cause presenile cataracts?
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MAD:
Myotonic dystrophies, atopic dermatitis, Diabetes |
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In a standard 24 mm eye, how many Diopters is a 1 mm change equal to?
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1 mm = 3 D change in refractive error
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Unilateral golden brown refractile crystals freely floating in vitreous
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Synchisis Scintillans, due to chronic uveitis, vit heme, or trauma
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PVD sx and symptoms
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1. Acute Flashes and Floaters
2. Weiss ring (old connection w/ ONH) 3. Shafers sign (Tobacco dusting) |
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Strongest to weakest vitreal attachments
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Vitreous base > Posterior lens > ONH > Macula > retinal vessels
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most common vaso-occlusive dz
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BRVO
(aside: CRAO > BRAO) |
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Complications from CRVO and BRVO
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Macular dz (ischemic and edema) & neovascular complications (pre ret and vit hemes)
CRVO: neo glauc can happen w/in 90 days |
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DM and HTN are common in pts with vaso-occlusive ds, what are common in just CRAO and BRAO pts?
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Carotid occlusive and cardiac valve disease
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2 types of CRVO
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Non perfusion (<20/200), perfusion
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What are the causes of CRAO?
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Carotid emboli, heart (calcific) emboli
GCA, Sickle cell, collegen vascular ds |
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5 main causes of blindness from DR
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mac dz: Edema, ischemia
PDR: Vit heme, Tractional RD, Neo Glauc |
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CSME
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1. retinal thickening w/in 500 um of fovea
2. retina thickening of 1DD w/in 1DD 3. hard exudates w/in 500 um of fovea w/ adjacent ret thickening |
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Name the layers:
Flame hemes, CWS, Hard exudates, drusen, dot blot hemes |
Flame and CWS: NFL
Hard exudates and dot blots: INL Drusen: under RPE |
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Early HTN retinopathy sx
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Inc ALR, arteriole narrowing, AV nicking
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Stage 3 HTN retinopathy sx
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Flame shaped hemes, CWS, hard exudates
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elsching spots vs Elschnig pearls
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Spots are choroidal infarcts in severe HTN. Pearls are post capsule opacities in kids after cataract extraction
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Dot blot hemes in MID-Peripheral fudus
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Ocular ischemic syndrome
Also: dilated non tort veins, small arterioles, and neo of disc and iris |
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Abnl capillaries around the fovea, causing right angle venules and exudate around the macula
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Idiopathic Juxtafoveolar Retinal Telangiectasia
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Unilateral hard exudates in a yound make. Lots of exudates, enough to ause leukocoria
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Coats Disease
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What makes a baby premature?
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<36 weeks, and <2k grams
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Last area of retina to develop?
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Anterior temporal, the BVs have to travel the furthest from the ONH. Takes 9 mos of gestation to develop temp retinal vessels
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3 things that cause Luekocoria and Strabismus in kids
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1. Coats Dz
2. ROP 3. Retinoblastoma |
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the 4 Wet AMD presentations
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1. SubRet Heme - looks red
2. SubRPE Heme - looks green 3. SubRet Detach - plasma under ret (serous) 4. SubRPE detach - plasma under RPE (PED) |
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the 4 main risk factors for dry to wet AMD
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1. Multiple soft drusen (esp confluent)
2. focal hyperpigmentation 3. HTN 4. Smoking |
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bamboo spine, sacroilitis, uveitis, and aortic regurgitation
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Ankylosing spondylitis
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Unilateral sudden blurred vision in a YOUNG person
May be high strung |
Central Serous
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Histoplasmosis triad:
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1. PPA
2. CNV 3. Histo spots |
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Posterior staphylomas, oblique insertion of ONH, laquer cracks and Fuch's spots
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High myopia
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Mild Epiretinal membrane
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Cellophane
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Advanced epiretinal membrane
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Macular pucker
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Mechanism for epiretinal membrane formations
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Break in ILM --> glial cells from retina accummulate on top of ILM. Contractionof the glial cells leads to wrinkling
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Which stage of macular hole?
Yellow spot |
Stage 1
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Which stage of macular hole?
Small full thickness hole (red), w/ psuedo-operculum |
Stage 2
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Which stage of macular hole?
Large full thickness hole (red) w/operculum |
Stage 3
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Which stage of macular hole?
Full thickness hole (red) w/ operculum and PVD |
Stage 4
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What can cause CME?
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Cataract surgery! And anything to cuase intraocular inflamm:
DM, BRVO, uveitis, RP, ARMD, Coats, vasculitis |
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After shining a bright light in an eye for 10 sec, how long should it take for pt to be able to reaqd 1 line less thanBCVA?
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1 minute. This is the photostress test
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Describe the ERG findings for an RP patientq
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Normal photopic ERG
Reduced scotopic ERG |
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RP triad
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1. Bone spicules
2. Arteriolar attenuation 3. Waxy Optic Disc Pallor |
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RP + hearing loss
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Usher's syndrome
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granulomatous palpebral conj + preauricular + submandibular lymphadenopathy
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Parinaud's oculoglandular syndrome
(from Cat scratch) |
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Name the disease:
Mottling of RPE and Pisciform yellow flecks, normal ERG |
Early Stargardt's
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Name the disease:
Beaten bronze retinal appearance, abnormal ERG |
Late stargardt's
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Which is worse, stargardt's or fundus flavimauclatus?
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Stargardt's. Pts with fundus flavimaculatus do not have macular dystrophy signs
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A young pt presents with night blindness. What are the 2 ddx's? Which has a better px?
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RP: AD, triab of spicules, waxy ONH pallor, and arteriolar attenuation
Choroideremia: X linked recessive. Visible sclera. Macula spared till late stages of the dz (50-60) so better px |
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4 things that cause bulls eye maculopathy
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1. Stargardt's
2. Cone dystrophy 3. Chloroquine/hydropxychloroquine 4. Thioridazine toxicity |
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Signs of cone dystrophy
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Abnl photopic ERG
Bulls eye maculopathy small vessels temp. ONH pallor fine nystagmus |
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Macular dystrophy with an abnormal EOG and normal ERG
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Best's / Vitelliform
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Which macular dystrophy results from the inability to break down ornithine?
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Gyrate atrophy
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What systemic disease area associated with KC?
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T-DOMME
Turners, Downs, Osteogenisis imperfecta, Marfans, Mitral valvle prolapse, Ehlers Dnalos |
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Retinoschisis is most common in which quadrant?
Lattice? BRVO? |
retinoschisis: inferior temporal
Lattice/BRVO: Superior Temporal |
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What is the splitting of the OPL called?
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Retinoschisis
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Define ocular htn
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IOP >21 on consecutive visits w/ no glaucomatous optic neuropathy.
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Top risks for conversion of Ocular HTN to POAG are:
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IOP
Afro's Fam Hx (esp siblings) Age Thin corneas |
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DDx IOP of NTG and POAG
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21 mmHg
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Port wine stains are assoc with what?
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Ipsilateral glaucoma and Sturge Weber syndrome
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Sampeolesi's line
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Pigment anterior to shwalbe's line, usually in PXE or Pigment dispersion syndrome
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2 most common causes for primary angle closure glaucoma
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Pupillary block and plateau iris
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Mid dilated pupil that responds poorly to liught is indicative of what?
Hint: pt will have a red eye, a bad head ache, and N & V. |
Primary angle closure glaucoma
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2 types of secondary angle closure
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Neovascular glaucoma (CRVO, DM)
Uveitis glaucoma (Sticky iris during inflammatio) |
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2 types of Inflammatory glaucoma
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Glaucomatocyclitic crisis
Fuch's Heterochromic Iridocyclitis |
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High IOP (40-50 mmHg) w/o angle closure. Commonly with a mild anterior chamber reaction
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Glaucomatocyclitic crisis
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