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78 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Number 1 cause of reversible blindness?
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Cataracts
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Number 1 cause of irreversible blindness?
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Glaucoma
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Most common type of glaucoma in the USA?
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PAOG
primary open angle |
not the most common worldwide, just USA
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Order of the anterior chamber structures (in aqueous outflow)?
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ciliary body band --> scleral spur --> pigmented trabecular mesh --> non-pigmented trabecular mesh --> schwalbe's line
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secondary pathway for aqueous outflow is the uveoscleral path (is IOP independent)
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What drug is contraindicated if someone has closed angle glaucoma?
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Epinephrine
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What is the tx for acute narrow angle closure glaucoma?
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Laser Peripheral Iridotomy
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creates a hole that allows fluid to drain around iris; instant relief;
will usually laser other eye as well (likely have predisposition) |
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What area of vision is affected first by glaucoma (PAOG)?
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peripheral vision affected first
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Old woman w/ unilateral vision loss, jaw claudication, weakness?
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Temporal Arteritis
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Labs = Elev ESR/CRP
Bx = Giant cell arteritis Tx = High dose corticosteroids ASAP |
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Innervation of the EOM CN's?
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CN VI = lateral rectus
CN IV = superior oblique CN III all the rest |
mnemonic = (LR6SO4)3
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What is the relay station for visual info before the primary visual cortex?
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lateral geniculate nucleus
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How do you stain for a corneal abrasion?
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Fluorescein stain
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Green lights up in areas w/o epithelium
Want to rinse the eye w/ Abx or sterile sol'n |
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What is a "Cherry Red Spot"?
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It's a deep red spot representing the macula (which is relatively devoid of cellular layers) which is contrasted w/ the rest of the retina that is opaque
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d/t central retinal artery occlusion (macula gets blood from choroid artery)
or storage diseases (tay sach's) |
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Where does Central Retinal Artery Occlusion occur?
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at the level of the optic nerve, as it enters the lamina cribrosa
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Inflammation @ back of eye, fine cells in the vitreous, and white nodules under the retinal pigment epithelium?
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Primary CNS Lymphoma
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Dx = Bx of vitreous showing large b-cell lymphoma
Tx = whole brain rads/chemo Avg age = 54 |
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What causes congenital ptosis?
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Dystrophy of the levator muscle; results in poorly defined upper eyelid crease, and is bilateral 25% of the time; must tx to prevent amblyopia
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Tx = Frontalis sling or Sx to shorten/strengthen the lebator muscle (depending on the level of fx/dysfx of the muscle)
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What's the most common type of Acquired Ptosis?
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Involutional aka aponeurotic aka senile ptosis
The levator still fx's, it just d/t stretch, dehiscence, or disinsertion of the levator aponeurosis |
Other forms of acquired ptosis are:
- neurogenic (horners, CNIII, MG) - traumatic - mechanical |
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What is Dermatochalasis?
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Extra eyelid skin that can block the superior visual field; tx = sx to remove
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What is Blepharitis?
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Inflamed anterior eyelid margin; can be inflammatory or infectious (in which case it's commonly Staph)
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What is the most common eyelid malignancy?
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BCC = basal cell carcinoma
(usually lower eyelid - more UV exposure) |
Characteristics:
- nodular - ulcerated center - rolled border (pearly/translucent) - non-tender - fine telangiectactic vessels - local invasion (no mets) |
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What type of eyelid cancer can metastasize to lymph nodes or have Pagetoid spread?
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Sebaceous Cell Carcinoma
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Commonly involves upper eyelids; mimics chronic chalazion or blepharitis; basophilic cells w/ foamy cytoplasm; loss of eyelashes
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Most common ocular tumor of childhood?
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Retinoblastoma
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Most common primary intraocular malignancy of adults?
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Choroidal Melanoma
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What are the classic symptoms of Congenital Glaucoma?
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1) Epiphora (excessive tearing)
2) Photophobia 3) Blepharospasm (twitch of the eyelids |
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Buphthalmos?
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Enlarged eye
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Sign of congenital glaucoma
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Haab's Striae?
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Tears in Descemet's membrane of the cornea
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Sign of congenital glaucoma
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Where do most lacrimal duct obstructions occur?
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The valve of Hasner
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Most resolve sponteneously
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Dacrocystitis?
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Infection of the lacrimal sac
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How do you tell b/w Orbital or Pre-septal Cellulitis?
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If the eye can move during exam, it's pre-septal (PO Abx); if it cannot, it's an emergency!
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If orbital cellulitis spreads you can get cavernous venous thrombosis or meningitis; need to give IV Abx and/or Sx drainage (abscess)
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What are the most common causes of Orbital Cellulitis?
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Sinusitis (adjacent sinus; usually ethmoid) and Dental Work
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Signs of Grave's Ophthalmopathy?
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- Eyelid retraction (most common)
- Exophthalmos - Optic neuropathy and restrictive strabismus d/t enlarged EOM's |
EOMs are enlarged d/t glycosaminoglycan deposition; note: are tendon sparing
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Tx of Thyroid Eye Disease?
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- Smoking cessation
- Regulate thyroid - Steroids - Orbital decompression (break bones to relieve pressure on the optic nerve) |
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What is Conjunctival Intraepithelial Neoplasia?
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Faulty epithelial maturation; can't metastasize w/o invasion (like cervical CIN); usually d/t UV or HPV 16/18
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HPV 16/18 cause cervical hyperplasia/CIN as well; they are both similar in that they don't metastasize until they've invaded the BM
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What parts of eye are responsible for refraction?
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Cornea = 2/3
Lens = 1/3 |
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What are the major layers of the lens?
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Capsule
Cortex Nucleus (hard) |
Capsule is supported by zonular fibers attached to the ciliary body
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How is accommodation accomplished?
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Ciliary muscle contracts --> Zonular fibers relax --> Lens is allowed to bulge
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Accommodation allows for near vision; lost in older age as lens becomes "harder"
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Characteristics of cataracts?
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Painless opacities of the lens (cortex or nucleus)
Signs = glare @ night, decreased contrast, more myopia and monocular diplopia |
Sx is ONLY indicated if cataracts interfere w/ ADL's
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What are some causes of cataracts?
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Congenital rubella
Marfan's syndrome Rx's DM |
Rx's include:
- Chloropromazine - Amiodarone |
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What are important things to check for in evaluation of cataracts for Sx?
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Cornea (look for fuch's dystrophy)
Macular degeneration (sets expectations) |
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Cataract Surgery?
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Phacoemulsification:
- no stiches (tiny incision) - local anesthesia - high frequency U/S breaks lens --> remove cloudy lens - IOL implant |
After cataract Sx, you lose natural accomodation
IOL can be put in posterior (usually) or anterior chambers |
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What is myopia?
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"Nearsightedness"
Cornea is too steep / too focused Light focuses in FRONT of retina |
Far point is close to the eye
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Tx of Myopia?
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Bi-Concave lenses --> push focal point back (mini-fy objects)
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Power of lens related to far point:
-1.00 = 1m -3.00 = 3m |
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Disorders associated w/ Myopia?
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Retinal detachment
PAOG |
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What is hyperopia?
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"Farsightedness"
Cornea is too flat / axial length is too short Light focuses BEHIND retina |
Young people don't need glasses b/c they use accommodation to alter their focal point
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Tx of Hyperopia?
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Convex Lenses --> Increase focusing power
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Disorders associated w/ Hyperopia?
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Close Angle Glaucoma
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Description & Tx of astigmatism?
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Lens problem prevents focusing on retina (blurry focus)
Tx = Toric lens (for regular astygmatism); contact lenses for irregular |
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What is presbyopia?
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The loss of accomodation d/t stiffening of the lens
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Affects hyperopic and emmetropic patients
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Lamellar Sx?
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LASIK & PRK
Change corneal shape |
Better for myopia
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PRK
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Photorefractive keratectomy
- Pain (~ corneal abrasion) - good for thin cornea (too thin for LASIK) |
Goal = 20/40
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LASIK
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Laser Assisted in Situ Keratomileusis
- Change shape/thickness - Improves UNcorrected vision only |
Does not correct presbyopia (still need reading glasses)
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Thermal Refractive Sx?
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LTK (Laser Thermo) & CK (Conductive) Keratoplasty
- shrink collagen @ the periphery |
Good for hyperopia (can shorten the focal length and induce myopia)
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Dx of glaucoma?
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High IOP (by Tonopen, Applanation Tonometry)
Optic nerve damage Vision loss |
See an increased Cup:Disc ratio
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RF's for Open Angle Glaucoma (PAOG)?
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Age, Black, DM
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Tx for Open Angle Glaucoma (PAOG)?
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Drops --> Laser --> Sx
(all w/ the goal of lowering the IOP) |
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65 y/o Asian woman with sudden onset of unilateral eye pain, blurry vision, nausea & vomiting?
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Closed Angle Glaucoma
(acute narrow angle closure glaucoma) OPHTHALMIC EMERGENCY |
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EOM: Down & In?
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Superior obliques
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EOM: Up & Out?
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Inferior obliques
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Ophthalmic emergencies?
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1) Acute Closed/Narrow Angle Glaucoma
2) Temporal/Giant Cell Arteritis |
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What is abmlyopia?
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"Lazy Eye" d/t failed development of visual cortex (lateral geniculate)
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Can be corrected in childhood if picked up; fixing underlying problem & then patching of "good" eye for certain periods of time to allow "lazy eye" to catch up
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Waht is Strabismus?
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Lack of coordination of EOM's
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One eye is fine and the other exhibits "tropia" (blatant eye deviation); can be:
- Eso (cross) - Exo (out) - Hyper (up) - Hypo (down) |
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What is Leukocoria?
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White pupillary reflex
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URGENT referral b/c it could be retinoblastoma
(can also be congenital cataract or persistant hypertrophic primary vitreous) |
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Meibomitis?
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Inflammation of posterior eyelid margin
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What type of inflammation is a chalazion? What causes it?
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Lipogranulomatous inflammation
d/t meibomian gland obstruction (sebum builds up and causes inflammation) |
Not infectious
Tx = warm compresses; if serious, then incision/drainage |
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Causes of corneal ulcers?
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Herpes Simplex
Contacts (& other trauma) |
Sometimes have infiltrate that is a combo of WBC's and bacteria
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What are flashes & floaters a sign of?
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Retinal detachment!!
also will describe "curtain" (will be opposite visual field from actual tear) |
More common in myopia.
Tears = horseshoe |
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Tx and complications of HSV Keratitis Dendrite?
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TOP Antivirals and debriedment.
If un-tx'ed can lead to uveitis or stromal involvement. |
HSV live in ganglia
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What muscles are affected in horizontal diplopia?
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Medial and lateral recti
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If vasculopaths (50+ y/o) can resolve on own (DM/HTN/etc)
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What do you do if diplopia has pupil involvement?
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Neuroimaging!
Could be an aneurysm |
Pupil fibers are on the outside of the nerve fiber therefore if they are affected, that means there is compression on the nerve bundle.
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What is a blowout fracture & how do you evaluate it?
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Something large strikes the eye, so the weakest bone (floor) fractures
You do a Forced duction test |
Inferior Rectus and Nerve can be entrapped.
+ forced duction means there's trapping and it cannot move - forced duction means it can move and might therefore be a nerve palsy |
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Classic signs of central retinal vein occlusion?
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Hemorrhage &/or Infarct
Hemosiderin deposition |
If it's a branch, there is blind spot of peripheral vision
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Pathophysiology of Grave's Ophthalmopathy?
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Ab's cross react w/ TSH-R on the orbital fibroblasts
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Usually occurs in HYPERthyroid
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Characteristics of proliferative diabetic retinopathy?
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Ischemia --> VEGF release
neovascularization (of retina AND iris --> rubeosis iridis) the new vessels break & fibrose |
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Tx of proliferative diabetic retinopathy?
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Anti-VEGF's = Bevacizumab
Pan-retinal photocoagulation (but can damage rods --> night blindness) |
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Characteristics of non-proliferative diabetic retinopathy?
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Leaking pericytes lead to:
- dot/blot hemorrhages - hard exudate - macular edema - cotton wool spots |
Dot/Blot hemorrhages are blood in the outer plexiform layer of the retina
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Characteristics of dry macular degeneration?
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Atrophic/graudal
Drusen deposition --> thickening of bruch's membrane --> nutrient flow disrupted --> photoreceptors atrophy |
Is basically a slow degeneration of the RPE
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Characteristics of wet macular degeneration?
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Exudative = Damage choroidal epithelium
- new choroid capillaries - weak/leaky --> fibrosis and hemorrhage |
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Tx for dry macular degeneration?
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Vitamins from AREDS study:
- Vit C, Vit E - Zn, Cu - ß-Carotene |
Antioxidants slow down the damage to RPE
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Tx for wet macular degeneration?
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Anti-VEGF = Bevacizumab
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Anti-VEGF's are the only things to improve vision in wet macular degeneration
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