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37 Cards in this Set
- Front
- Back
Myopia
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Nearsighted
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Hyperopia
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Farsighted
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Strabismus
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ocular misalignment to 5% of children that can lead to...ambylopia. Strabismus often treated first with muscle training with surgery limited to severe abnormalities.
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Amblyopia
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inadequate visual stimulation of the brain during critical visual development, may result in irreversible blindness. Can occur following strabismus, injury, severe myopia, retinopathies, tumors, or cataracts. Must be treated early or is irreversible. Does not usually occur after age 5.
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Diplopia
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Double vision
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Esotropia
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inward gaze- most common
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Exotropia
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outward gaze
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Hypertropia
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upward gaze
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Hypotropia
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downward gaze
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Hirschberg Test (corneal light reflex)
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shining a light towards the eyes, light should be reflected at exactly the same spot in the two corneas.
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Anisocoria
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disequal pupils, common to 20-25% of population, may vary from day to day, usually 1mm, same in bright or dim light, no dilation lag
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Horner's syndrome
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smaller pupil, ptosis, hypochromic iris (if congenital) from cervical sympathetic pathway abnormality, usually more pronounced in dim light with dilation lag
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Epicanthal Folds
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skin fold from inner canthus to mid-upper eyelid, becomes less noticeable throughout childhood (common findings in Down Syndrome)
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Brushfield spots
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freckled spots on iris (common findings in Down Syndrome)
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Hypertelorism
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increased distance between nasal walls of orbits(common findings in Down Syndrome)
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Exophtalmos
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outward displacement or protuberance of the eye
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Proptosis
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outward displacement of an organ, i.e. eye( so basically synonymous with exophthalmos)
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Retinoblastoma
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most common intraorbital malignancy in children
-usually diagnosed between ages 1 to 5 years -most detected by parents noting leukocoria ( an abnormal white reflection from the retina of the eye) |
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Neuroblastoma
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most common orbital malignancy in children
-proptosis and ecchymosis |
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Microphthalmos
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smaller eye(s) may be associated with other congenital opthalmic problems, i.e. cataracts
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Buphthalmos
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distended, enlarged eye from intraoccular pressure, i.e. glaucoma or tumor
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Glaucoma
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corneal edema and increased intraoccular pressure
-photophobia, blepharospasm (any abnormal contraction or twitch of the eyelid), increased tearin, irregular cornal, & blurred red reflexes, corneal hazy, thin bluish sclera, increased myopia as globe size increases -may lead to amblyopia if untreated |
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Coloboma
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2 forms:
1. cleft of the eyelid may be upper and usually associated with syndromes such as Goldenhar or Treacher-Collins 2. Iris defect usually inferior and nasal in location. -may be isolated defect or associated with other syndromes |
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Ptosis
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dysfunctional levator muscle.
-may develop after chronic steroid eye drop use or chronic irritation -usually a sigh of some other disorder |
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Hordeolum
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Inflammation of gland of Zeis, usually painful, inflamed lid.
- remember that "hordeolum hurts" - casually referred to as "styes" - antibiotics rarely warranted, warm compress for comfort |
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Chalazion
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inflammation of meibomian glands, painless inflamed lid tarsus.
- may leave scar nodule on lid margin - casually referred to as "styes" - antibiotics rarely warranted, warm compress for comfort |
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Dacryocystitis/stenosis
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an infection of the nasolacrimal sac, frequently caused by nasolacrimal duct obstruction
-30% newborns complete patency of caniculi (nasolacrimal duct) not present-- very common -usually worsens with URI, rhinorrhea not present due to obstruction - massage duct until 6 months of age usually recommended (effectiveness if questioned) |
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Conjunctivitis
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inflammation of conjunctiva (clear epithelial covering of sclera & inner eyelids; mucus membranes)
- most common ophthalmic problem noted in primary care - may be cause by infections (bacterial/viral), toxins, or allergens - neonate after 2 days of age most commonly from gonococcus or chlamydia which is associated with systemic disease - viral form highly contagious |
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Blepharitis
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erythema, crusting of the eyelash border
-may be related to seborrhea - usually chronic - more common in children with Down syndrome |
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Cellulitis
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Periorbital: preseptal, eyelid and facial involvement, chemosis, and purulent drainage, usually unilateral
Orbital: septal pain, decreased ocular motility, proptosis, vision loss, abnormal pupil response, may spread intracranially, have dental disease, sinusitis, or metastases - both may initiate systemic infection - can be very difficult to differentiate -both occur quickly -- overnight |
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Cataract
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a clouding that develops in the crystalline lens of the eye or in its envelope, varying in degree from slight to complete opacity and obstructing the passage of light
- May be congenital or acquired; unilateral or bilateral. - Amblyopia develops quickly |
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Corneal Abrasion
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Cornea is clear, epithelia layer with rich sensory innervation
-extremely common -especially with disabled who are unable to inform caretaker of problem -treat with antibiotics and eye patching for no longer than 24 - if pain continues for >24H refer to ophthalmologist |
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Chemical injuries
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- only true EMERGENT ophthalmic emergency
-every second of ophthalmic contact with chemical can lead to further tissue/vision damage. - must flush eye(s) immediately - Flush with at least 2 liters of water or LR per eye (when in doubt do both eyes)...until pH is 7 - alkali products common in home/garage are most damaging (household cleaners, garden products, automotive lubricants) - home- flush eye under faucet until paramedics arrive (never drive to hospital/MD-- time is vision) |
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Hyphema
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ruptured iris blood vessel or ciliary body resulting in blood and increased pressure in the anterior chamber
- may have significant concurrent, globe, orbit, or head injury -rebleeding in 3-5 days a concern -AT RISK FOR GLAUCOMA & VISION LOSS -may require sx intervention (keep NPO and HOB 30) -treatment contraversial (include: bedrest, eye patching, avaoiding val salva maneuver, acetazole &/or atropine to reduce intraocular pressure, and Amicar to reduce bleeding potential) |
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Orbital Fractures
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May have significant concurrent, globe or head injury
-most common is orbital fracture w/ entrapped musle to maxillary sinus (may need sx --keep NPO) - orbital roof fractures may allow CSF drainage, lateral walls may damage optic nerve - waters view radiographs and CT of orbit and sinuses helpful |
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Lid Lacerations
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- laceration and animal bites may have non-apparent penetrations of the globe or cranial vault.
- Canalicular and nasolacrimal duct injury common with lower, medial wounds. - Repair to"gray line" or conjunctiva/skin border must be meticulous for good cosmetic effect. - Eyebrows are never to be shaved prior to skin closure - keep NPO for sedation or surgical correction |
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Penetrating Trauma
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- May have significant, concurrent skin, orbital, sinus, or cranial vault injury
- sclera tissue repairs itself very quickly even immediate exams difficult - Do not remove embedded foreign objects (immobilize object and patient) - waters view radiographs and CT may be helpful - retained wood reported to develop severe fungal infections -may require sx intervention (keep NPO & HOB 30) |