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215 Cards in this Set

  • Front
  • Back
Lazy eye is called _
AMBLYOPIA
How do you test vision in children from birth to 3 years of age
Forced preferential looking

Fixation preference

Fighting occlusion
How do you test vision in children from 3 to 5 years old
Tumbling E

Allen pictures

HOTV
How do you test vision in kids ages 5 and up
Snellen acuity chart
Diminished visual acuity (usually by 2 lines) not due to any organic pathological condition is called _
AMBLYOPIA
What is the etiology of amblyopia
Lack of neurosensory stimulation due to conflicting images ( strabismus) or blurred retinal image
Leading cause of visual impairment in childhood
Amblyopia
What are the causes of amblyopia
Strabismus

Unequal refractive errors

Form deprivation
What is the most common cause of amblyopia and why
STRABISMIC AMBLYOPIA - childs brain is still adaptive - there will be suppression of the image from deviated eye
Amblyopia that results from difference in refractive errors between eyes is called _
Anisometropia
Form deprivation amblyopia is called _

What is it caused by?
Amblyopia ex anopsia - caused by inadequate sensory input due to opacity in ocular media or occlusion of the eye - cataracts, corneal scars, ptosis
What is the treatment of amblyopia
- Early recognition
- Treatment of underlying cause
- Occlusion therapy - patch better seeing eye
- Pharmacological penalization - blurring good eye with cycloplegic eye drop
Deviation of eye inward is called _
ESOTROPIA
Deviation of eye outward is called _
EXOTROPIA
Deviation of eyes upward is called _
HYPERTROPIA
Deviation of eyes downward is called _
HYPOPIA
Neonatal conjunctivitis is also called _
OPHTHALMIA NEONATORUM
What are the routes of inoculation for neonatal conjunctivitis
- Ascending infection from vagina and cervix after premature rupture of membranes
- Genitourinary secretions at time of birth
- Contact with contaminated materials or persons during neonatal period
What is the most common type of neonatal conjunctivitis
Chlamydia conjunctivitis
Clinical presentation of chlamydial neonatal conjunctivitis
Onset 5-14 days after infections

Presents as acute purulent conjunctivitis
Signs and symptoms of neonatal conjunctivitis
- Hyperemia and edema of eyelids
- Papillary response of palpebral conjunctiva
- Hyperemia and injection of bulbar conjunctiva
- Preauricular lymphadenopathy
- Possible systemic involvement
How do you diagnose chlamydial conjunctivitis
- High index of suspicion
- Clinical presentation
- Giemsa stain of conjunctival scrapings (basophilic inclusion bodies)
- Direct immunofluorescence study of conjunctiva
Treatment of chlamydial conjunctivitis
Prophylaxis - topical erythromycin - ophthalmic ointment at time of birth
Infants - oral erythromycin or sulfa agents, adjunctive topical erythromycin
Parents - oral erythromycin or tetracyclin
Describe clinical presentation of neisserial conjunctivitis
Onset - 2-6 days after birth
- Rapidly progressing infection
- Copious purulent drainage, chemosis, lid edema
- Complications - corneal perforation with endophthalmitis
How would you diagnose neisserial conjunctivitis
- High index of suspicion
- Clinical presentation
- Laboratory work up mandatory -gram stain of conjunctiva revealing gram negative diplococci, gonoccocal cultures and sensitivities
Infection or inflammation confined to eyelids and periorbital structures anterior to orbital septum is called _
Pre-Septal Cellulitis
Active infection or inflammation of orbital soft tissues posterior to orbital septum is called _
Orbital cellulitis
What are clinical findings of ORBITAL CELLULITIS
Fever
Proptosis - forward movement of the eye - exophthalmos
Chemosis - edema of conjunctiva
Restriction of ocular motility
Pain with movement of the eye
DECREASED VISION
PUPILLARY ABNORMALITY - afferent pupillary defect
Decreased vision and afferent pupillary defect in ORBITAL CELLULITIS suggest _
Involvement of orbital apex and require investigation and immediate treatment
Causes of orbital cellulitis
EXTENSION FROM PERIORBITAL STRUCTURES (paranasal sinuses, face and eyelids, ducts, dental, etc)

EXOGENOUS CAUSES - trauma, post op

ENDOGENOUS CAUSES - bacteremia with septic emboli

INTRAORBITAL - endophthalmitis, panophthalmitis
Which organisms are common cause of orbital cellulitis
Staph
Strep
H. influenzae - children
Anaerobes
Polymicrobial infections due to sinus infections
Most common abnormality of nasolacrimal system
Dacryostenosis
Signs and symptoms of Dacryostenosis
Mucopurulent drainage

Secondary blepharitis

Epyphora - excessive tearing
Dacryostenosis treatment
- Broad spectrum antibiotics

- Creiger maneuver - massage of nasolacrimal sac

- Probing and irrigation of nasolacrimal system
Most common intra-ocular malignancy in childhood
Retinoblastoma
Most common intra- ocular malignancy in adults
Choroidal melanoma
What symptom is present in 56% of kids with retinoblastoma
Leukocoria (white pupil)
Treatment for retinoblastoma
Enucleosis
Leading cause of childhood blindness
Infantile cataracts
What is the clinical presentation of infantile glaucoma
Corneal edema

Eye enlargement

Epiphora

Photophobia
Give examples of blinding diseases that are potentially treatable if discovered early
Glaucoma

Diabetic retinopathy

Macular degeneration

Retinal detachment

Amblyopia
Potentially vision or life threatening systemic disorders that may involve the eye include
Diabetes

Hypertension

Temporal arteritis

Embolism from carotid artery of the heart
When you assess risk factors for ocular disease which history points should you discuss
Family history (blindness, glaucoma, ocular tumor, retinal detachment, strabismus, macular degeneration)

Poor vision (excluding refractive error)

History of eye trauma

Medical history (diabetes mellitus, hypertension, thyroid disease, RA, malignancy)
The outer structures that protect eyeball and lubricate ocular surface.
EYELIDS
The space between two open lids is called _
Palpebral fissure
The transparent front "window" of the eye that serves as major refractive surface
CORNEA
The thick outer coat of the eye normally white and opaque
SCLERA
The junction between cornea and sclera
LIMBUS
The thin vascular mucous membrane covering the inner aspect of the eyelids and sclera
CONJUNCTIVA

covering eyelids - palpebral

covering sclera - bulbar
The space that lies between the cornea anteriorly and iris posteriorly _

This chamber contains _
ANTERIOR CHAMBER

Aqueous humor
The colored part of the eye that screens out light primarily via pigmented epithelium which lines its posterior surface
IRIS
The transparent biconvex body suspended by zonules behind the pupil and iris - part of refracting mechanism of the eye
LENS
The structure that produces aqueous humor
CILIARY BODY
The small space filled with aqueous humor behind iris and in front of the anterior lens capsule
POSTERIOR CHAMBER
The relatively large space behind the lens that extends to the retina - the cavity is filled with a transparent jelly- like material
VITREOUS CAVITY
Portion of the optic nerve visible within the eye - it is composed of axons whose cell bodies are located in the ganglion cell layer of the retina
OPTIC DISC
The neural tissue lining the vitreous cavity posteriorly - essentially transparent except for the blood vessels on its inner surface, sends visual signals to the brain via optic nerve
RETINA
Which structures make up eye fundus
Retina

Macula

Choroid

Optic disc
The area of retina at posterior pole of the eye responsible for fine, central vision
MACULA
The oval depression in the center of the macula
FOVEA
Vascular pigmented tissue layer between sclera and retina - provides blood supply to outer retinal layer
CHOROID
Provides approximately 2/3 of refractive power of the eye
CORNEA
Provides 1/3 of refractive power of the eye
LENS
Reduced visual acuity due to the fact that eye is too short
HYPEROPIA
Reduced visual acuity due to the fact that eye is too long
MYOPIA
Reduced visual acuity due to refracting power of the cornea and lens is different in one meridian than in another
ASTIGMATISM
The ability of the ciliary muscle to contract and the lens to become more convex is called _
ACCOMODATION
Loss of accomodation that leads decreased ability to focus on near objects while corrected visual acuity in distance remains normal
PRESBYOPIA
VA stands for _
Visual acuity
OD stands for _
Right eye
OS stands for _
LEFT EYE
OU stands for
Both eyes
CC stands for _
With correction
SC stands for _
Without correction
When do you perform tonometry?
If suspect acute narrow angle glaucoma
When is anterior chamber depth assesment performed and why?
When narrow angle glaucoma is suspected and prior to pupillary dilation
Confrontation field testing is done for what?
Used to confirm a suspected visual field defect suggested by the patients history of symptoms, also used to document normal visual field
When would you do color vision testing?
May be part of examination if requested by patient or another agency, in patients with retinal or optic nerve disorders and in patients taking certain medications
When is fluorescein staining of cornea necessary?
When corneal epithelial abnormality or defect is suspected
When is upper lid eversion necessary?
When presence of foreign body is suspected
Distance visual acuity is recorded as ration or fraction - what does numerator stand for? denominator stands for?
Numerator represents distance between the patient and eye chart

Denumerator represents the distance at which a person with normal acuity can read the letters
Amsler grid tasting tests for _
Macular scotomas
A shallow anterior chamber may indicate _
Narrow angle glaucoma
In patient with which condition should tonometry be never attempted?
In patient suspected of having ruptured globe - could result in further damage to the eye
Recommended agents for pupillary dilation
Tropicamide 1%

Phenylephrine hydrochloride 2.5%
If assesment of anterior chamber depth shows a shallow chamber should you still dilate a eye
DO NOT dilate an eye because an attack of angle closure glaucoma might be precipitated
At what angle should direct ophthalmoscopy be done?
15 degrees temporal to patients line of sight
Optic disk lies _ to center of retina
NASAL
Name order of examination of structures in direct ophthalmoscopy
Optic disk

Retinal blood vessels

Retinal background

Macula (and fovea)
What is normal red reflex and what does it signify
Normal red reflex - evenly colored and not interrupted by shadows, evidence that cornea, anterior chamber, lens and vitreous are clear and not significant source of decreased vision
How would opacities in the ocular media - such as corneal scar, cataracts and vitreous hemorrhage appear on ophthalmoscopy and when can they be best appreciated?
Appear as black silhoettes and can be best appreciated when pupil is dilated
When viewed through ophthalmoscope how does normal optic disk appear
Slightly oval in the vertical meridian and has pink color due to extremelly small capillaries on surface, disk edge or margin should be identifiable (sharp)
Central whitish depression in the surface of optic disk is called _
Physiologic cup
Are retinal nerve fibers normally myelinated or non myelinated
Normally non myelinated
During ophthalmoscopy you see dense white superficial opacification of the optic disc with feathery edges - is this normal or pathologic
NORMAL variation - myelination of optic disc and retina
The ration of normal vein to artery diameter
3:2
How do you distinguish arteries from veins when you look with ophthalmoscope
Arteries are lighter in color and typically have more prominent light reflex than veins
How should examiner look at arteries and veins during eye exam
Follow arteries from disk and veins back to disk in each quadrant noting in particular arteriovenous crossings
Describe normal fundus background
Uniform red orange color due primarily to pigmentation of the retinal pigmented epithelium
Where is normal fovea located in relation to optic disc
Located directly temporal and slightly inferior to the optic disc
If during eye exam you see that fovea is slightly yellow, this is due to _
Xantophyll pigment in retina
A 14 year old boy is seen for physical examination at school. He admits to difficulty reading the blackboard but not in reading textbooks. He doesnt wear glasses. You record VA as OD 20/100, pinhole 20/25, and OS 20/100, pinhole 20/25 - what is your diagnosis? Would you manage or refer this patient?
The combination of decreased distance vision with preserved near vision is typical of MYOPIA which often becomes symptomatic during adolescence. Presumptive evidence of refractive error is provided by marked improvement in VA that occurs with use of pinhole. Patient should be referred to ophthalmologist as regular rather than urgent consultation
A 78 year old woman is seen for annual physical examination and complains of mild difficulty in reading and in seeing street signs. You record OD 20/70, no improvement with pinhole and OS 20/50, no improvement with pinhole. Upon direct ophthalmoscopy you notice dullness of red reflex and you have difficulty seeing fundus details in both eyes - what is your diagnosis? Would you manage or refer this patient?
CATARACT is common cause of painless progressive loss of vision in older individuals. Complains about visual ability are indication for referral to ophthalmologist for evaluation for possible cataract surgery
A 40 year old male is seen for annual physical exam, he has no complains and doesnt wear glasses. You record VA as 20/15 OD and 20/100 OS, no improvement with pinhole. During history patient revealed that he had lazy eye in his left eye since childhood - amblyopia - Would you refer this patient?
Referal is not indicated since the cause of decrased vision is established and progressive loss is not occuring.
50 year old man is visiting office because he noticed decreased VA in right eye when he accidentally occluded left eye. When his present glasses were prescribed 2 years ago, his vision was equal in both eyes. You record VA as OD 20/50, no improvement with pinhole and OS 20/20. No abnormalities detected on ophthalmoscopy - what if any is your diagnosis? Would you manage or refer?
Patient has unexplained loss of vision of unknown duration in one eye. An unexplained decrease in vision requires referal to ophthalmologist because it may indicate occult disease of the eyes or CNS that cannot be detected by PCP. For example this patient is suffering from macular disturbance detected only by methods available to ophthalmologist
64 year old woman visits your office complaining of flashing lights in peripheral vision. You obtain following details in your history - in her right eye only flashing light have been present for several days. Numerous small dark floaters accompany them. On the day of presentaiton she began to notice dark area in superotemporal visual field of the affected eye. Her VA is 20/20 in each eye and physical exam of undilated pupils is unremarkable What is your diagnosis?
Patients symptoms are very suspicious of RETINAL DETACHMENT and she should be examined by ophthalmologist urgently. History is key in making diagnosis. Duration, location and associated symptoms are all compatible with retinal tear or retinal detachment. Prompt referal is indicated despite lack of physical findings because peripheral retina is not readily examined with direct ophthalmoscope
First thing to be determined in evaluating acute visual loss is _
VA with best available correction in each eye
Positive swinging flashlight test indicates _
Relative afferent pupillary defect - MARCUS GUNN PUPIL
If patient presents with symptoms of blurred vision and on examination there is reduction of visual acuity and darkening of red reflex, what does it usually indicate?
Any significant irregularity or opacity of clear refractive media of the eye - cornea, anterior chamber, lens, vitreous chamber
Do media opacities cause relative afferent pupillary defect?
NO - although pupillary reflexes may be altered ( miosis in acute iritis or mid dilated and fixed pupils in acute angle-closure glaucoma)
Patient presents with dulling of normally crisp reflection of incident light off cornea. Cornea takes on ground glass appearance (crystall clear when healthy) - what is the diagnosis
CORNEAL EDEMA
Common cause of corneal edema
Increased intraocular pressure
Visual loss accompanying an attack of acute angle closure glaucoma is largely the result of _
Corneal edema
Other then increased intraocular pressure - common cause of corneal edema, what other conditions could be causing it
Corneal endothelial cell dysfunction due to dystrophies or sometimes following intraocular surgery - can result in corneal edema (but usually with gradual loss of vision, not acute)

Any acute inflammation or infection of cornea (herpes simplex keratitis) my mimick corneal edema
Blood in anterior chamber is called _
HYPHEMA
Do hyphemas always result in loss of vision
Any significant hyphema will reduce vision and complete hyphema will reduce vision to light perception only, lesser degrees of hyphema may not affect visual acuity
Most hyphemas are direct consequence of _
BLUNT TRAUMA TO THE EYE
Most hyphemas occur due to trauma but some things can lead to spontaneous hyphema (not associated with trauma) - name them
Presence of abnormal iris vessels - which occurs with tumors, diabetes, intraocular surgery and chronic inflammation - all causes of neovascularization
Do cataracts cause acute or gradual vision loss
Most cataracts develop slowly, rare patient may interpret rapid progression of cataract as sudden visual loss
In what cases can large vitreous hemorrhages occur
After trauma and in any condition causing retinal neovascularization - proliferative diabetic retinopathy, retinal vein occlusion or sickle cell retinopathy
_ may accompany subarachnoid hemorrahge and is one cause of visual loss from intracranial anerysms
VITREOUS HEMORRHAGE
If red reflex cannot be seen but lens appears clear - what should you suspect
Vitreous hemorrhage
Patient complains of flashing lights followed by large number of floaters and then a shade over vision in one eye --what is the diagnosis?

Is there relative afferent pupillary defect present?

How would retina appear on ophthalmoscopy?
RETINAL DETACHMENT

Relative afferent pupillary defect is present

Ophthalmoscopy through dilated pupil shows elevated retina with folds and choroidal background is indistinct
Is there relative afferent pupillary defect in macular disease
NO
Transient monocular visual loss due to arterial insufficiency is called _
AMAUROSIS FUGAX
In patient over 50 years old report of visual loss in one eye lasting for several minutes should lead to investigation of _
Ipsilateral carotid circulation looking for atheroma. Valves and chambers of heart should also be investigated looking for embolic source causing transient interruption of blood flow to retina
Should primary physician be managing retinal vascular occlusion
NO - referral should be made to ophthalmologist, neurologist or vascular surgeon
Prolonged interruption of retinal arterial blood flow causes permanent damage to _
Ganglion cells and other tissue elements
Central retinal artery occlusion manifests as _
Sudden painless often severe visual loss
Within minutes to hours of CRAO what would you see with ophthalmoscope?
Vascular stasis - narrowing of arterial blood columns and interruption of venous blood columns with appearance of "boxcarring" as rows of corpuscles are separated by clear intervals
What is the characteristic finding in the retina in patient suffering from CRAO
Pallor of perifoveal retina causing characteristic cherry red spot of CRAO
Is CRAO true ophthalmic emergency?
YES
As an emergency measure what should primary care physician be doing in patient with suspected CRAO
Compress eye with heel of hand pressing firmly for 10 seconds and then releasing for 10 seconds over period of approximately 5 minutes. Sudden rise and fall of intraocular pressure can dislodge small embolus in central retinal artery and restore circulation
Patient presents with partial vision loss, patient knows moment of vision loss and is able to describe or draw exact outline of the missing area of vision - what is the likely diagnosis
Branch Retinal Artery Occlusion (BRAO)
Patient is 78 year old male with history of hypertension and arteriosclerotic vascular disease presents with severe but gradual vision loss. Ophthalmoscopic examination reveals disc swelling, venous engorgement small white patches on the retina (cotton wool spots) and diffuse retinal hemorrhages. Fundus looks like "blood and thunder" - Diagnosis, is it a true ophthalmologic emergency?
Central Retinal Vein Occlusion (CRVO) - NOT a true ophthalmologic emergency
What is a late complication of CRVO
Neovascular glaucoma
Optic neuritis is inflammation of optic nerve that is usually idiopathic but can be associated with _ in significant number of cases
MULTIPLE SCLEROSIS
Name two regular features of optic neuritis
Reduced visual acuity and relative afferent pupillary defect
Patient presents with reduced VA and presence of relative afferent pupillary defect. Colors are desaturated and appear darker in affected eye. Upon examination optic disc appears swollen and hyperemic - the disc margin is blurred and no discrete edge can be discerned - diagnosis?

Should you manage or refer?

Treatment?
OPTIC NEURITIS

SHould refer to ophthalmologits

Rx - high dose IV corticosteroids
Patient is young adult who is experiencing monocular stepwise progressive loss of vision that has developed over hours to days and is accompanied by pain on movement of the eye however he shows no abnormalities on ophthalmoscopic examination - diagnosis

Is there afferent pupillary defect??
RETROBULBAR OPTIC NEURITIS

YES
Inflammation of optic disc is called _ and its a subtype of _
PAPILLITIS - subtype of optic neuritis
Swelling of the optic disc caused by increased intracranial pressure is called _ - is it unilateral or bilateral
PAPILLEDEMA

BILATERAL
How would you distinguish Papillitis (optic neuritis) from Papilledema
In papillitis (optic neuritis) vision is usually significantly decreased and examination of pupils reveals relative afferent pupillary defect. In PAPILLEDEMA visual acuity and pupillary reflexes are usually normal.

In both conditions fundus examination will reveal blurred optic disc margins and optic disc cupping is obliterated
If patient is diagnosed with PAPILLEDEMA what diagnostic test is emergently recommended
Emergent brain scan to identify intracranial mass
Patients with _ will have papilledema without midline shift on brain scan and spinal tap in necesary to document increased intracranial pressure
PSEUDOTUMOR CEREBRI
If older adult presents with swelling of the disc and visual loss which is more likely- vascular event or inflammation?
VASCULAR EVENT
Patient presents with acute VA and visual field loss. Exam reveals PALE, swollen disc accompanied by splinter hemorrhages - diagnosis?
Ischemic optic neuropathy
The field loss with ischemic optic neuropathy is often predominantly in superior or inferior field - this pattern is called -
ALTITUDINAL
Development of acute ischemic optic neuropathy in patient over age 60 raises high possibility of_
Giant cell or TEMPORAL arteritis
Patient is 67 year old female who complains of temporal headache and tenderness, causing her pain while resting on a pillow, scalp tenderness while brushing her hair, ear and anterior neck discomfort (carotidynia), fatigue and pain of the tongue and jaw with chewing (jaw claudication) and episodes of transient diplopia or visual loss. She also noticed increased anorexia, weight loss, general malaise and aching/fatigue of upper arms (polymyalgia rheumatica) - DIAGNOSIS
Giant cell arteritis
If patient presents with visual complaints + jaw claudication THINK _
Giant cell arteritis
In otherwise asymptomatic elderly patient who has ischemic optic neuropathy ( or even CRAO or unexplained ophthalmoplegia) which blood tests should you immediately order?
Sedimentation rate + C-reactive protein
In patient with giant cell arteritis sedimentation rate would be elevated or decreased?
ELEVATED (> 60 mm per hour)
In patient with elevated sedimentation rate or other symptoms of giant cell arteritis which treatment is mandatory?
High dose systemic corticosteroids
If giant cell arteritis is strong diagnostic possibility should you be managing this patient ?
NO - IMMEDIATELY REFER TO OPHTHALMOLOGIST
If you took biopsy of temporal artery in patient with giant cell arteritis what would you see?
Giant cells

Fragmentation of elastica with surrounding chronic inflammation

Occlusion of the vessel
Loss of vision on one side of BOTH visual fields is called _

It may result from occlusion of one of the _ arteries with infarction of _
HOMONYMOUS HEMIANOPIA

Posterior cerebral

Occipital lobe
Extensive bilateral damage to cerebral visual pathways resuling in complete visual loss is called _
Cortical blindness (also central or cerebral blindness)
Patient who has cortical blindness has normal pupillary reactions - EXPLAIN
Because pathways serving pupillary light reflex separate from those carrying visual information at level of optic tracts
Patient presents with complete blindness although normal pupillary reaction and normal fundus on ophthalmoscopic examination - DIAGNOSIS
CORTICAL BLINDNESS
Visual loss without organic basis is called _
FUNCTIONAL (hysterical or malingering)
Patient is 24 year old male who complains of complete blindness of one eye and normal vision in other eye but has normal stereopsis and no relative afferent pupillary defect - DIAGNOSIS
FUNCTIONAL vision loss
Name conditions that require emergency measures and referral
CRAO

RETINAL DETACHMENT

ISCHEMIC OPTIC NEUROPATHY is suspected to be related to giant cell arteritis
Significant cause of blindness in US and leading cause of blindness among African Americans
GLAUCOMA
What is normal range of intraocular pressure
10-21 mm HG
In glaucoma which vision is spared until late disease - central or peripheral
CENTRAL
What is the most important way to detect glaucoma in primary care setting
Examination of optic nerve
Describe flow of aqueous humor
Produced by ciliary body ---> flows through pupil into anterior chamber where its drained through trabecular meshwork to Schlemms canal and onward to venous system
Common insiduous form of glaucoma is called _
Open angle glaucoma
Type of glaucoma caused by sudden and complete occlusion of trabeculum by iris tissue that leads to rise in intraocular pressure is called_
Acute angle closure glaucoma
Patient presents with eye pain, nausea and colored halos or rainbows around light. Eye is red, teary with hazy cornea and fixed mid-dilated pupil. The eye feels extremely firm to palpation - DIAGNOSIS and what other finding would you expect to find in this patient
ACUTE ANGLE CLOSURE GLAUCOMA - will also find increased intraocular pressure
What should be size of cup and cup:disc ratio to suspect glaucoma
Cup measuring one half the size of the disc or larger - cup:disc ratio of 0.5 or more
Types of cataracts
Subcapsular, cortical or nuclear

Anterior or Posterior
Most common cause of cataract
Age related change (also trauma, inflammation, metabolic and nutritional defects and effects of corticosteroids)
Patients with nuclear cataracts can find that they can read without glasses - phenomenon called _
SECOND SIGHT
What is the leading cause of irreversible central visual loss (20/200 or worse) among people 50 years old or older
MACULAR DEGENERATION
Is macula composed of rods or cones?
BOTH
In fovea are there more cones or rods?
CONES
Hyaline nodules (or colloid bodies) deposited in Bruch's membrane which separates retinal pigmented epithelium (outermost layer of retina) from inner choroidal vessels are called _
DRUSEN
About 20% of eyes with age related macular degeneration develop _
Choroidal neovascularization - "wet" macular degeneration
Which vision is spared in patient with macular degeneration - central or peripheral
PERIPHERAL
Name disorders associated with red eye
- Acute angle closure glaucoma

- Iritis or iridocyclitis

- Herpes simplex keratitis

- Conjunctivitis

- Episcleritis

- Soft contact-lens associated

- Scleritis

- Adnexal disease

- Subconjunctival hemorrhage

- Pterygium

-Keratoconjunctivitis sicca

- Abrasions and foreign bodies

- Corneal ulcerations

- Secondary to abnormal lid function
Redness of the eye occurs in what type of glaucoam
Acute angle closure glaucoma
Iridocyclitis is inflammation of _

Often manifested by _
Iris and ciliary body

Ciliary flush
Herpes simplex keratitis is common potentially serious disease can lead to _
Corneal ulceration
Adnexal disease affects _
Eyelids, lacrimal apparatus and orbit, includes dacriocystitis, stye and blepharitis
Accumulation of blood in potential space between conjunctiva and sclera is called _
SUBCONJUNCTIVAL HEMORRHAGE
Abnormal growth consisting of triangular fold of tissue that advances progressively over the cornea usually from nasal side is called _
PTERYGIUM
Blurred vision that improves with blinking suggests _
Discharge or mucus on ocular surface
Patient presents with red eye and severe pain - what is your differential diagnosis
Acute closure angle glaucoma

Keratitis

Ulcer

Iridocyclitis
Patient presents with red eye + scratchiness and mild irritation - diagnosis
Conjunctivitis
Patient presents with red eye + photophobia - diagnosis
Iritis either alone or secondary to corneal inflammation
Patient presents with colored halos (rainbows) + red eye - diagnosis
Acute glaucoma of the eye
Patient complains of red eye and exudation, he states that his eyelids are "stuck together" upon awakening - possible diagnosis
Conjunctivitis or eyelid inflammation ( NOT glaucoma or iridocyclitis)
Patient complains of red eye + itching - diagnosis
Allergic conjunctivitis
Patient presents with red eye + reduced visual acuity - differential diagnosis
Inflamed cornea

Iridocyclitis

Glaucoma
Injection of deep conjunctival and episcleral vessels surrounding cornea is called _
Ciliary flush
Patient presents with ciliary flush + red eye - seen most easily in daylight it looks like faint violaceous ring in which individual vessels are indiscernible to unaided eye - possible diagnosis
Glaucoma

Iridocyclitis

Corneal inflammation
Patient presents with red eye and keratic precipitates - diagnosis
Iritis or chronic iridocyclitis
Patient presents with red eye and diffuse haze obscuring the pupil and iris markings characteristic of _ - likely diagnosis
CORNEAL EDEMA - acute glaucoma
How would pupil look like in iridocyclitis
Smaller - due to reflex spasm of iris sphincter muscle
Most common cause of chronic proptosis
THyroid disease
Sudden proptosis suggests _
Serious orbital or cavernous sinus disease, in children - orbital infection or tumor
Red eye + purulent or mucopurulent discharge =
Bacterial infection
Red eye + serous discharge =
Viral infection
Enlargement of lymph node just in front of auricle + red eye =
Viral conjunctivitis
Upper respiratory infection + red eye + fever - what the cause?
ADENOVIRUS (pharyngoconjunctival fever)
Serious systemic disorder possibly an allergic response to medication which can result in severe conjunctivitis, irreversible conjunctival scarring and blindness. Patient presents with bulls eye lesions on the skin - diagnosis
Erythema multiforme - Stevens- Johnson syndrome
Acute usually sterile inflammation of glands of hair follicles of the eyelid
Stye or HORDEOLUM
Chronic inflammation of meibomian gland in the eyelid that may develop spontaneously or may follow a hordeolum
Chalazion
A persistent or recurring lid mass should undergo biopsy - why?
Because it may be rare meibomian gland carcinoma or squamous cell carcinoma of the lid rather then benign chalazion
Bony, concave cavity in the skull housing the globe, extraocular muscles and blood vessels and nerves of the eye
ORBIT
Protects globe from impact with large objects
Rim of orbit
Will rim fracture cause decrease in vision
Rim fracture usually causes no decrease in ocular or visual function
Medial fracture of thin ethmoid bone may be associated with _
Subcutaneous emphysema