• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/216

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

216 Cards in this Set

  • Front
  • Back
chemical burns
alkali burns are worse b/c breakdown fatty acids in membrane. (hydroxide, lime, cement, plaster, ammonia, air bag residue)
can increase IOP
rinse with water/saline
red eye good b/c tissue alive
white eye bad, tissue dead
corneal abrasion
need hx of trauma
epithelial defect with infiltrate
AC reaction, miotic pupil
seidels
uses to diagnose perforated cornea.
leak (positive) dark stream in fluorescein
commotio retinae
gray white coloration in retina due to trauma. if located in macula=Berlins edema.
resolves on its own.
looks like white without pressure.
hyphema
blood in AC due to blunt trauma, sick cell, clotting disease
orbital floor fracture
blow out fracture breaks maxillary bone
pain, diplopia, crepitus, enophthalmos, angle recession
trapped IR (limits upgaze)
preseptal cellulitis
infection anterior to orbital septum
most common cause hordeolum
orbital cellulitis
infection behind orbital septum
decreased vision, pain on eye movement
ddx: feeling ok preseptal, sick orbital
ethmoid sinusitius #1 cause
can result: cavernous sinus thrombosis, brain abscess, meningitis. mucormycosis (fungal infection immunocompromised)
graves ophthalmopathy
proptosis and upper lid retraction
females 8:1
von graefes, kotcher, SLK, restriction upgaze (due to IR/ MR swelling)
biggest concern is compression ONH
kochers sign
stare appearance due to upper lid retraction in Graves disease
von graefes sign
lid lag down gaze due to graves disease
carotid cavernous fistula
abnormal communication between artery/vein
extreme red/chemosis on involved side
CN VI palsy due to increased pressure
pulsatile propstosis. elevated IOP
causes: head trauma rupture aneurysm
cavernous hemangioma
most common begnign orbital tumor adults
decrease vision, diplopia, proptosis
orbital tumor
APD, progressive proptosis, diplopia, progressive VA loss
capillary hemangioma
most common benign orbital tumor kids
can cause deprivation amblyopia
70% lesions gone by 7
rhabdomyosarcoma
most common primary pediatric orbital malignancy
rapid onset progressive proptosis
bone tumor
neuroblastoma
most common secondary pediatric orbital malignancy, poor prognosis, sudden ptosis
tumor neural crest cells that metastasized
meningioma
most common middle aged women
primary orbital tumor or sphenoid meningioma (most common intracranial tumor to spread to orbit)
dermoid cysts
contain sebaceous glands
associated goldenhar's syndrome: ocular dermoid, preauricular skin tags, vertebral dysplasia
most common epibulbar tumor of childhood
lymphoma
more common 50-70, proptosis
50% with orbital involvement develop systemic dz, 90% 5 year survival
optic nerve glioma
most common 2-6, most common intrinsic tumor of ON, associated neurofibromatosis type 1.
orbital pseudotumor
20-50, unilateral pain, diplopia, proptosis, increase IOP, reduced corneal sensation
idiopathic inflammatory process
bilateral: think wegners, polyarteritis nodosa, lymphoma
tolosa hunt syndrome
idiopathic inflammation of cavernous sinus
pain, diplopia
remember 3,4,6, V1, V2 pass through
V3, V7 dont
ocular rosacea
females, norther european ancestr
telangiectasia, rhinophyma, facial flushing.
triggers
contact dermatitis
type 4. recent change make up.
ocular cicatricial pemphigoid
symblepharon, ankyloblepharon
systemic mucous membrane disoreder
dermatochalasis
common condition in elderly
weakened orbital septum, fat pushes through
chalazion
hard nodule without pain, redness
inflammation meibomian gland. hx acne rosacea.
hordeolum
pain, redness, caused by staph infection of meibomian gland (internal) zeis/moll (external=stye)
ectropion
age related most common cause
paralytic due to CN VII palsy (affects riolans muscle)
entropian
age related most common
ulceration worst case scenario
floppy eyelid syndrome
obese men with sleep apnea
chronic red eyes in morning
chronic papillary conjunctivitis
spontaneous lid eversion during sleep
benign essential blepharospasm
involuntary bilateral twitching
orbicularis oculi, procerus, corrugator muscles.
idioopathic most common
myokymia
unilateral twitching eye lid of orbicularis oculi
meiges syndrome
blepharospasm + lower facial abnormalities
sebaceous gland carcinoma
rare. elderly females
if get recurrent chalazion think about this.
yellow and hard (chalazion flesh colored)
arises from meibomian glands, 60% risk death
ketatoacanthoma
tumor eyelid due to UV.
grows quickly and spontaneous resolves.
canaliculitis
smoldering unilateral red eye. swollen puncta (pouting puncta), discharge with palpation, actinomyces most common cause.
dacryoadenitis
lacrimal gland inflammation
acute: bacterial infection
chronic (more common): sarcoid
s shaped ptosis
Jones I test
evaluate ability tears to pass through lacrimal drainage
fluorescein instilled, wait 5 min look for in patients throat or blow their nose.
positive = patent (normal)
negative-->jones II
Jones II
use saline to irrigate nasolacrimal drainage
if it comes out punctum same side -->canalicular blockage
comes out punctum other eye-->nasolacrimal blockage
positive= patent pt tastes saline
negative= pt doesn't taste saline, still blocked.
primary acquired melanosis
elderly white pts. unilateral
30% progress to malignant melanoma
acquired melanoma on conj
conjunctival melanoma
arises from PAM
pigmented or non pigmented
thickness of lesion is big indicator to progression to melanoma (increase melanocytes)
metastasize more commonly SCC
conjunctival intraepithelial neoplasia
rare premalignant condition non pigmented lesion on conj with neo (leads to squamous cell carcinoma)
conjunctival squamous cell carcinoma
malignant tumor on conj arises from conjunctival intraepithelial neoplasia (CIN)
most common cause discharge
bleph
bacterial conjunctivitis
rare, redness, discharge
kids: H. influenzae
adults: staph aureus, staph epidermidis
gonococcal conjunctivitis
hyperacute redness.
purulent discharge, pseudomembranes, marked preauricular lymphadenopathy
due to neisseria gonorrhea can invade intact cornea
adenoviral conjunctivitis
most common virus that affects eye
more common adults than kids
follicular conj, injection, preauricular adenopathy, pseudomembrane, SEI (indicate no longer contagious)
result from UTI
epidemic keratoconjunctivitis
viral conj due to adenovirus 8 and 19
see in adults, corneal involvement (SEI's 80%)
pharyngoconjunctival fever
viral conjunctivitis due to adenovirus 3,7
triad: acute follicular conjunctivitis, mild fever, pharyngitis
more commonly affects children
swimming pool
molluscum contagiosum
dome shaped waxy nodules
due to poor hygiene
caused pox virus, multiple think HIV
seasonal allergic conjunctivitis
itchy, type 1 hypersensitivity
papillae
inflamed, central vessel
non-specific
see with bacterial, allergic conj
follicles
avascular, white/grey, nodules
follicles: chlamydia, toxic, viral
vernal keratoconunctivitis (VKC)
male children. seasonal.
bilateral papillae, limbus (trantas dots), upper palpebral conj (cobblestone), corneal involvement (shield ulcer)
atopic keratoconjunctivitis
most common young adults with hx atopic dermatitis
itchy eyes. dennies lines (folds skin from rubbing eyes)
papillae inferior, small
giant papillary conjunctivitis
itchy eyes, large papillae
decreased CL wearing time.
more common with silicone hydrogel
chlamydia trachoma
leading cause of preventable blindness 3rd world.
spread housefly.
chronic conjunctvitis (A-C)
Arlt lines: white scarring superior tarsal conjunctiva
Herberts pits: depression limbal conjunctiva
corneal ulcer
superior limbic keratoconjunctivitis
most common middle age females
bilateral superior conj redness
"velvety appearance"
associated thyroid eye disease, poor cl fit
phyctenulosis
white lymphocytic nodule with dilated vessels surrounding.
delayed hypersensitivity rxn (type 4)
due to bleph, TB, acne rosacea
parinauds oculoglandular syndrome
red eye unilateral granulomatous palpebral conjunctivitis, preauricular/submandibular lymphadenopathy
due to: cat scratch fever
pediculosis
blood tinged debris on lids/lashes, preauricular lymphadenopathy, chronic conjunctivitis, itchy
caused by phthirus pubis
ddx demodicosis (from mites, sleeving eyelash, asymptomatic)
subconjunctival heme
redness conjunctiva
ask strain, bleeding disorder, medications (aspirin, coumadin), HTN
order PT/PTT if recurs
episcleritis
common. young adults
acute unilateral painless red eye.
sectoral (70%), simple or nodular (can be moved),
tx: steroid
ddx: phenyl (constricts episcleral vessels)
scleritis
rare. female.
red painful eye
anterior most common. nodular or necrotizing with or w/o inflammation.
necrotizing with is worst, 25% pts die.
necrotizing w/o is usually result RA.
most common type anterior uveitis
unilateral, acute, anterior, non granulomatous
anterior uveitis
pain, redness, photophobia (acute)
asymptomatic (chronic).
most commonly idiopathic
diagnosed: cells AC
decreased IOP affected eye, PAS, PS, cataract, KP
due to breakdown blood aqueous barrier
signs chronic anterior uveitis
koeppe nodules, mutton fat KPs, busacca nodules
acute non-granulomatous uveitis causes
AK, Reiters, IBD, Behcets, lyme, glaucomatocyclitic crisis
chronic granulomatous uveitis causes
TB, sarcoid, HSV, HZO (increased IOP), syphilis
chronic non-granulomatous uveitis
JRA, fuchs heterochromic iridocyclitis
meds that cause uveitis
rifabutin, systemic sulfonamaides, cidofovir
posterior uveitis
floaters, decreased vision, WBCs vitreous, break down blood aqueous barrier
causes posterior uveitis
toxoplasmosis (most common), histoplasmosis, sarcoidosis, syphilis, pars planitis (young pts), CMV
exposure keratopathy
dryness cornea due to exposure
SPK to ulceration
cause: bell's, thyroid
decreased corneal sensitivity
filamentary keratopathy
history of dry eye
filament=epithelial cells + mucous
dry eye
more common with aging.
two types: evaporative (lipid problem), keratoconjunctivitis
burning, itching, worse at end of day, red (most common cause)
meds cause dry eye
antihistamines, b-blockers, estrogen therapy, oral contraceptives
evaporative dry eye causes
deficient lipid secretions of meibomian glands, zeis glands, eyelid related problems (decreased blind)
keratoconjunctivitis sicca
due to aqueous tear deficiency
test dry eye
schirmer test (5 min, unanesthetized >15mm reflex, basal. anesthetized >10 basal)
phenol red: >10
TBUT: >10
vogts striae
stromal vertical stress lines associated with keratoconus
corneal hydrops
ruptured descemets membrane associated with keratoconus (worst case scenario)
rizzutis sign
conical reflection on the nasal cornea when light is shown from temporal side
associated keratoconus
keratoconus
non-inflammatory condition starts with bowman damage. most commonly begins around pubert
mild <48D
moderate: 48-54 D
severe: >54D
keratoconus associated with
VKC, AKC, turner, down, osteogenesis, marfans, mitral valve prolapse, ehlers danlos.
T-DOMME
fleischers ring
iron deposits cornea base of cone due to keratconus
hudson stahli lines
middle to lower cornea appear in elderly
stockers line
leading edge pterygium
ferry line
leading edge filtering bleb
kayser fleischer ring
copper accumulation edge cornea due to wilsons disease
pellucid marginal degeneration
corneal thinning early adulthood.
kissing doves topography.
thinnest area inf crescent cone
keratoglobus
congenital AR diffuse corneal thinning.
complication: descemet membrane rupture
associated: ehlers danlos, blue sclera, lebers congenital amaurosis
ABMD
most common anterior corneal dystrophy AD.
90% will not develop corneal erosions
map lines, dots, fingerprints corneal epithelium
meesmans
AD, asymptomatic, multitude epithelial cysts.
reis buckler dystrophy
AD, RCE, abnormal development collagen bowmans.
macular dystrophy
stromal corneal dystrophy AR.
mucopolysaccharide deposits and cloudy cornea
granular dystrophy
AD, most common stromal dystrophy.
hyaline deposits.
RCE deposits rare
lattice dystrophy
AD. stromal
amyloid deposits. RCE
schnyders dystrophy
AD. current/past high cholesterol
stromal cholesterol deposits.
ask high cholesterol
associated xanthelesma
kayser fleischer ring
copper accumulation edge cornea due to wilsons disease
pellucid marginal degeneration
corneal thinning early adulthood.
kissing doves topography.
thinnest area inf crescent cone
keratoglobus
congenital AR diffuse corneal thinning.
complication: descemet membrane rupture
associated: ehlers danlos, blue sclera, lebers congenital amaurosis
ABMD
most common anterior corneal dystrophy AD.
90% will not develop corneal erosions
map lines, dots, fingerprints corneal epithelium
meesmans
AD, asymptomatic, multitude epithelial cysts.
reis buckler dystrophy
AD, RCE, abnormal development collagen bowmans.
macular dystrophy
stromal corneal dystrophy AR.
mucopolysaccharide deposits and cloudy cornea
granular dystrophy
AD, most common stromal dystrophy.
hyaline deposits.
RCE deposits rare
lattice dystrophy
AD. stromal
amyloid deposits. RCE
schnyders dystrophy
AD. current/past high cholesterol
stromal cholesterol deposits.
ask high cholesterol
associated xanthelesma
fuchs endothelial dystrophy
AD. females 50-60.
blurred vision worse in morning
endothelial guttata, increased polymegathism, polypleomorphism
thick pachymetry
bullae and scarring late sign due to decreased ability endo pumps
less than 500 cells/mm2 leads to corneal edema, 2000 expected at 70.
hassel henle
guttata due to increased thickness descemets in periphery
posterior polymorphous dystrophy
AD, early in life. innocuous usually. endothelial prob.
corneal edema and bullae can occur. 15% glaucoma
megalocornea
x linked, high myopia. astigmatism.
>13mm horz diameter
associated: ehlors, marfans, osteogenesis
risk glaucoma, lens subluxation
microcornea
AD or AR.
horz diameter <10mm
hyperopic risk glaucoma
cornea plana
rare, AD or AR
flat cornea <38 D.
sclerocornea
rare, bilateral vascularization of peripheral cornea.
80% associated cornea plana
haab's striae
horz cracks in descemets membrane due to increased IOP from congenital glaucoma
posterior embryotoxin
anterior schwalbes line. normal variant.
small percent get glaucoma
axenfelds anomaly/syndrome
posterior embryotoxin + iris strands
50-60% develop glaucoma (syndrome if develop glaucoma)
riegers anomaly
posterior embryotoxin, iris strands, displaced pupil and iris atrophy
50-60% develop glaucoma
syndrome: mental retardation, dental, facial, skeletal abnormalities
peter's anomaly
central corneal opacity with iris adhesions
50% develop secondary glaucoma
aniridia
rare bilateral AD
partial-complete loss iris
glaucoma 75%, foveal hypoplasia, disc hypoplasia
bacterial keratitis
most common cause corneal ulcer
red eye, pain, photophobia, decreased VA
ulcer=infiltrate+epithelial defect
cause: pseudomonas (can perforate), staph epi, staph aura, haemophilus influenzae, moraxella
cl wear, esp extended wear
bacteria that can invade intact cornea
Canadian National Hockey League
Corneybacterium diphtheriae, neisseria gonorrhea, haemophilus, listeria
fungal keratitis
cause: filamentous (aspergillus, fusarium), non filamentous (candida, immunocompromised)
hx: vegetative trauma, steroid use
pain, photophobia
feathery edges with surrounding satellite lesions
culture: sabourauds
acanthamoeba keratitis
parasitic infection
associated with inadequate cl hygiene, hot tub use
pain is severe and out of proportion to signs
stromal infiltrates or defects that appear pseudodentritic
ring ulcer (late finding)
culture heat killed E. coli agar
HSV
DNA virus, young pts.
hides CN V comes out wit stress, old, HIV, immunocompromised
epithelial keratitis: dendritic ulcer edges stain RB
disciform keratitis: stromal
IK: dense stromal edema
blepharoconjunctivitis: vesicles/crusting, follicles, preauricular lymphadenopathy
leading causes blindness US
#1 corneal trauma
#2 stromal scarring due to HSV
herpes zoster virus
affects elderly. if less than 40 suspect HIV.
prodrome, post herpetic neuralgia
hutchinsons sign: pustules side of nose
skin lesions respect dermatomes, upper eyelid only, conjunctivitis, episcleritis
pseudodendrites: no terminal endbulbs, entire lesion stains RB, fluorescein doesn't stain
hutchinsons triad
IK, teeth deformities, deafness
seen with congenital syphilis
moorens ulcer
forms: unilateral older pt (most common). young, bilateral, aggressive, nigerian males
peripheral gray infiltrate stromal, followed by epithelial defect 360.
idiopathic. associate hep C
infiltrate
immune mediated response. not a sign of infection
terriens marginal degeneration
corneal degeneration. rare. men over 40.
asymptomatic, ATR, decreased acuity.
bilateral. thinning starts superior. associated vascular pannus.
idiopathic
salzmanns nodular degeneration
females
smooth elevated blue-gray stromal opacities
results from: chronic keratitis (trachoma, phylectenulosis, dry eye, IK)
limbal girdle vogt
age related corneal degeneration
asymptomatic
bilateral opacities 3 and 9 o'clock. no clear zone between it and limbus
band keratopathy
due to gout/hypercalcemia
calcium deposits bowmans at 3 an 9 oclock.
corneal arcus
most common peripheral corneal opacity
bilateral lipid deposition bowmans, descemets
clear zone separation btw it and limbus
if present under 40 lipid profile warranted
crocodile shagreen
stromal opacities bowmans.
corneal degeneration
corneal farinata
AD or senile change.
corneal degeneration
flour dust deposits deep stroma central
graft rejection
type 4. 30% pts will have in 1 year
khodadoust line: endothelial rejection line
krachmers spots: SEI, stromal rejection
absolute contraindications refractive surgery
<21, refractive instability, keratoconus, CL warpage, immunosuppression, active HSV, CT, unrealistic expectations
complications all refractive surgery
dry eye, halos, glare, starbursts, irregular astigmatism, endophthalmitis
LASIK complications
ecstasia, flap wrinkles, DLK, disturbed tear function
LASIK
laser in situ keratomileusis
excimer laser to midstroma
complications PRK
regression, steroid induced glaucoma, corneal haze
PRK
photorefractive keratectomy
remove epithelium with chemicals and apply laser to bowmans
complications radial keratotomy
hyperopic shift, perforation, diurnal fluctuation
posterior subcapsular cataracts
in front of posterior lens capsule
affect near vision more
due to x-ray, steroids
presenile cataracts
associated DM, myotonic dystrophy, wilsons disease, hypocalcemia, atopic dermatitis
vossius ring
iris pigment on anterior lens capsule
toxic cataracts
anterior subcapsular
chlorpromazine, amiodarone, miotics, gold salts
secondary cataracts
anterior uveitis (most common), high myopia, RP, gyrate atrophy
lens subluxation
most common due to trauma
marfans, ehlers danlos, homocystinuria
striate keratopathy
corneal edema/ folds descemets membrane post cataract surgery
meds to be concerned with cataract surgery
anticoagulants, tamsulin
elschnig pearls
type of posterior capsular opacification
most often seen in children who undergo cataract surgery
irvine gass syndrome
CME after cataract surgery
most common reasons decrease VA after cataract surgery
asteroid hyalosis
calcium phosphate in normal vitreous
associated with aging
no visual consequences
synchysis scintillans
rare. golden brown cholesterol crystals in vitreous.
occurs after chronic uveitis, vitreous hemorrhage or trauma
PVD
prevalence approximates age (ie 50, 50%)
floaters, flashes of light
weiss ring (detached ONH)
vitreous hemorrhage
most common cause diabetes.
occurs when vitreous pulls on neo and vitreous face isn't intact
pre-retinal hemorrhage
between vitreous and retina
hemorrhage due to neo (diabetes)
CRVO
HTN, DM.
unilateral painless VA loss.
hemorrhages all 4 quadrants due to obstruction CRV due to thrombus.
complications: macular disease, neo (major concern 90 glaucoma)
ischemic: 10 DD capillary nonperfusion FA and VA <20/200
nonischemic usually recover to 20/40
BRVO
HTN, DM.
more common than CRVO.
most common retinal vascular occlusive disease.
asymptomatic or unilateral VA loss.
complications: neo, macular
1 quadrant hemes, sup temp most common due to thrombus
CRAO
HTN, DM, carotid occlusive disease, cardiac valve disease
more common than BRAO's.
if young ask IV or birth control
VA loss 20/400 or worse
APD, cherry red spot if cilioretinal artery. whitening all 4 quadrants due to emboli. possibly GCA.
neo glaucoma rare.
BRAO
HTN, DM, carotid occlusive disease, cardiac valve disease.
asymptomatic or unilateral VA loss
white 1 quadrant, permanent VF loss.
most commonly results from cholesterol plaque (hollenhorst plaque)
diabetic retinopathy
leading cause of new blindness in US
due to damage to blood retinal barrier as pericytes are lost
most important risk factor is duration of insulin dependent diabetes
two threats to vision DR
Macular (edema, ischemia most common reason for legal blindness)
PDR (vitreous heme, tractional RD, neo glaucoma)
high risk characteristics of proliferative DR
neo greater than 1/4 DD
any NVD or NVE with vitreous/ pre retinal heme
CSME
retinal thickening within 500 microns (1/3 DD) of foveal center
HE within 500 microns of foveal center with adj thickening
retinal thickening 1DD within 1 DD foveal center
HTN retinopathy
stage 3: flame shaped hemorrhage, CWS, HE
stage 4: papilledema, macular star
elschnig spots
choroidal infarcts apparent in severe HTN retinopathy
Ocular ischemic syndrome
more common men 50-80.
gradual VA loss, periorbital pain, amaurosis fugax
unilateral dot/blot hemes midperipheral, dilated non tortuous veins, neo disc and iris
due to carotid atherosclerosis, GCA
idiopathic juxtafoveolar retinal telangiectasia
three types: unilateral congenital (men 40s moderate VA loss), unilateral idiopathic form (mild VA loss), bilateral acquired form (poor prognosis)
right angle venules and varying degrees exudate near fovea
abnormal perifoveal capillaries
coats disease
males less than 20.
decreased unilater VA, strabismus, leukocoria
unilateral telangiectatic vessesls with light bulb appearance, hard exudates
ROP
infants born less than 36 weeks or that weighs 2,000 g or less and has received oxygen therapy
leukocoria and strabismus
anterior temporal last region to develop
proliferative retinopathy
ARMD
most common pts >50. exudative ARMD chief cause VA loss pt >50.
dry AMD-asymptomatic
wet AMD-rapid onset vision loss
RPE abnormalities, geographic atrophy
wet AMD-drusen with neo membrane
12% dry severe vision loss
wet AMD- subretinal hemorrhage, sub-RPE hemorrhage, subretinal detachment (serous RD), sub-RPE detachment (PED)
risk factors increase risk progression from dry to wet ARMD
multiple soft drusen, focal hyperpigmentation, HTN, smoking
categories AMD
1: few or small drusen
2: several small drusen or a few medium sized drusen
3: several medium size drusen, 1 or more large drusen
4: GA or wet AMD
central serous choroidopathy
men type A 20-50
sudden onset blurred vision, metamorphopsia
localized serous macular detachment
smokestack appearance FA
sympathetic nervous system hyperactivity
histoplasmosis
most common ohio-mississippi river valley
asymptomatic
triad: peripapillary atrophy, multifocal lesion periphery, maculpathy (CNV)
fungal infection
high myopia
>6D or axial length 26 mm
decreased VA
posterior staphylomas, fuchs spots, lacquer cracks (break bruchs), macular holes, cataracts
fuchs spots
hyperpigmented spots in macula from RPE hyperplasia
epiretinal membrane
more common females. glistening membrane (cellophane), advanced--macular pucker.
break ILM with glial proliferation due to PVD, retinal breaks
macular holes
aging women
decreased VA.
stages: 1: impending-loss foveal depression with yellow spot/ring. 2: round with pseudo operculum. 3: large full thickness with operculum. 4: stage 3 + PVD
idiopathic
watzke allen sign
slit lamp light appears broken to pt
CME
intraocular surgery, previous uveitis
decreased VA.
loss foveal reflex, foveal thickening
macular photostress test
determine BCVA, hold bright light 2cm from pts eye, pt look at light 10 sec, measure time to til patient can read one line less than BCVA.
should be less than 60 sec.
RP
AD, also non inherited
most common retinal dystrophy
associated with Ushers (hearing loss)
night blindness, peripheral VA loss
triad: bone spicule pigmentation, arteriolar attenuation, waxy optic disc pallor
due to loss RPE and photoreceptor function
stargardts
6-20 onset. AR. most common hereditary macular dystrophy.
rapid VA loss, color vision abnormalities
pisciform flecks, beaten bronze macular pattern
choroideremia
x linked recessive, onset 1st decade
night blindness, peripheral VA loss.
progressive bilateral diffuse atrophy of RPE and choriocapillaris. macular spared until late stages.
cone dystrophy
1st-3rd decade. AD.
decreased central VA, severe photophobia, severe color VA loss
normal fundus, abnormal ERG
VA: 20/400
ddx bull's eye maculopathy
stargardts, progressive cone dystrophy, chloroquine and hydroxycholorquine and thioridazine toxicity
best's disease (vitelliform dystrophy)
AD, 5-10.
decreased VA or asymptomatic
bilateral, yellow, round, subfoveal, egg yolk lesion, may have CNV, atrophy.
decreased EOG, normal ERG
adult foveomacular vitelliform dystrophy
patients 30-50. like best's with better prognosis. normal EOG and ERG
gyrate atrophy
AR.
nightblindness, decreased VA, constricted VF.
macula spared until 4th-7th decade, high myopia and astigmatism.
due to ornithine aminotransferase deficiency
RD
males, over 45, most commonly in myopes with or without trauma.
vitreous floaters, curtain over vision, Va loss. undulating retina
schafers sign=pigment anterior vitreous.
pigment line present with chronic.
associated lattice degeneration.
non rhegmatogenous RD
RD due to traction (PDR) or serous (ARMD)
age related degenerative retinoschis
more common over 40.
asymptomatic
most common inferiotemporal, retinal is immobile, absolute VF defect.
hyperopic pts.
splitting OPL
angioid streaks
pseudoxanthoma elasticum most common cause of systemic causes. idiopathic 50%.
asymptomatic or VA loss from CNV.
PEPSI.
break Bruchs.
ocular HTN
>21 on two or more visits with open angle and without optic neuropathy.
risk factor for POAG
IOP (only one we can control), race (AA), family history, age, thin corneas
sturge weber
ipsilateral glaucoma
vascular birth mark.
POAG
optic nerve damage with IOP >21.
asymptomatic until later in disease, then peripheral VA loss.
most important sign: ONH change.
VF: nasal steps most common
pseudoexfoliation
age related with caucasians.
most common identifiable cause of elevated IOP and glaucoma.
see sampaolesi's line.
unilateral.
pigment dispersion syndrome
bilateral, more common young caucasians. 50% develop glaucoma.
asymptomatic, halos after exercise or dilation. more common myopes and males.
kruckenbergs spindle
normal tension glaucoma
type of POAG with IOP <21. diurnal IOP important to make sure not POAG. open angle.
drance hemorrhage more common. females greater risk, esp japanese.
VF defects: more focal and dense. inferotemporal rim most often affected.
primary angle closure glaucoma
highest risk after coming down from full dilation.
two causes: pupillary block, plateau iris syndrome (less common)
ocular pain, headaches, halos, progressive VA loss.
hazy cornea, mid dilated pupil with poor response to light, glaucomflecken, occluded angle gonio, IOP 50-100.
greatest threat to vision is CRAO.
sub acute most common.
secondary angle closure glaucoma
neo and uveitis
neovascular glaucoma
severe VA loss. CRVO most common cause then DR. examine pupillary margin.
uveitic glaucoma
due to PAS and PS. sticky iris due to inflammation.
inflammatory glaucoma
glaucomatocyclitic crisis and fuchs heterochromic iridocyclitis
glaucomatocyclitic crisis
aka posner schlossman
acute trabeculitis.
IOP 40-60 with open angle.
mild anterior chamber rxn
fuchs heterochromic iridocyclitis
chronic non granulomatous anterior uveitis