What is the best treatment option for penetrating trauma of the eye?
Refer to ophthalmology asap. DO NOT REMOVE FOREIGN BODY.
What does a rust ring on the cornea indicate?
Metallic foreign bodies and best way to remove it is using a rotating burr OR refer to ophthalmology.
What is the first step of an alkali or acidic burn of the eye?
Flush with sterile water or saline for at last 30 minutes. Place an eye shield on the eye and refer to ophthalmology.
What is a blow out fracture and how does it often present?
Blunt trauma that causes the orbital floor composed of maxillary, palatine and zygomatic bones to fracture, which results in trapping of the orbital structures. Patient often present with swelling and misalignment. Movement of globe is often restricted, s
Corneal Abrasion
Pain and sensation of foreign body and can be accompanied by photophobia, tearing, injection and blepharospasm. A slit-lamp or flurosecein staining will reveal an epithelial defect, but a clear cornea. Topical anesthetic should only be used for diagnosis.
Retinal Detachment
Definition: The underlying pathogenesis is a separation from the retina from the pigmented epithelial layer, causing the detached tissue to appear as flapping the vitreous humor. Usually begins at the superior temporal retinal area.
Symptoms: blurred/blac
What is considered a Marcus Gunn pupil?
A pupil with a relative afferent pupillary defected (RAPD)
Macular Degeneration
Definition: Macular degeneration is when drusen bodies are found on Bruch's membrane which leads to degenerative changes, loss of nutritional supply, atrophy and neovascularization.
Symptoms: Gradual vision loss
Exam: Decreased VA, Metamorphopsia (wavy or
Central Retinal Artery Occlusion
Central retinal artery occlusion is often due to emboli, thrombotic phenomenon or vasculitis.
Symptoms: Sudden, painless and marked unilateral vision loss.
Exam: Funduscopy reveals arteriolar narrowing, separation of arterial flow (box-carring), retinal e
Central Retinal Vein Occlusion
Central retinal vein occlusion usually occurs secondarily to a thrombotic event.
Symptoms: Sudden unilateral, painless blurred vision or completed vision loss.
Signs: Afferent pupillary defect and dilated veins, hemorrhages, edema and exudates of the reti
What is the leading cause of blindness in the U.S.?
Diabetic retinopathy
What is the leading cause of irreversible central vision loss?
Macular degeneration
What is the difference between non-proliferative and proliferative retinopathy?
Non-proliferative: venous dilation, microaneursyms, retinal edema, hard exudates
Proliferative: neovascularization, vitreous hemorrhage
Treatment of retinopathy?
Based on etiology. Optimized glucose control, regulation of BP, laser photocoagulation, virectomy. Severe disease is permanent.
Cataracts
Definition: Cataract is an opacity of the natural lens of the eye. They may develoop secondarily to natural aging process, trauma, congential causes or medications.
Symptoms: Insidious onset of decreased vision, may also complain of double vision, fixed s
What are two classes of medications that may lead to cataracts?
Corticosteroids, Stains (lovastatin book has listed)
Glaucoma
Glaucoma is increased intraocular pressure that results in optic nerve damage. Any impediment of the flow of aqueous humor through the trabecular meshwork and canal of Schlemm will increase pressure in anterior chamber. May be acute or chronic. Subtypes i
Angle-Closure glaucoma
Angle-Closure glaucoma is an ophthalmic emergency due to elevated intraocular pressure causing optic nerve damage.
Symptoms: Painful eye and loss of vision. Nausea, vomiting and diaphoresis are associated.
Exam: Circumlimbal injection, steamy cornea, fixe
Open-Angle glaucoma
Open-Angle glaucoma is a chronic, asymptomatic and potentially blinding disease defined as increased intraocular pressure, defects in the peripheral visual field and increased cup to disc ratios. Often affects people older than 40 and is more common in Af
Orbital Cellulitis
Primariiy occurs in children 7-12 years old.
Symptoms: Ptosis, eyelid edema, exopthalmos, purulent discharge and conjunctivitis
Signs: fever, decrease ROM of eye muscles and sluggish pupillary response
Labs: CBC, blood cultures, culture of drainage
Tests:
What are the most common causative agents of orbital cellulitis?
Streptococcus pneumoniae, staphylcoccus aureus, haemophilus influenzae and gram-negative bacteria.
Periorbital Cellulitis vs. Orbital Cellulitis
Periorbital cellulitis: inflammation and infection of the superficial eyelid, usually from a superficial source.
Orbital cellulitis: infection developing within the orbital soft tissue with associated ocular dysfunction and is usually due to underlying ba
Dacryostenosis
Dacryostenosis is when the lacrimal duct does not open and this obstruction usually resolves around 9 months of age. Treatment involves warm compresses or surgery if not resolved.
Dacryocysitis
Dacryocysitis is inflammation of the lacrimal gland causedby obstruction. Pain, swelling, tenderness and purulent discharge are charactersitic. Treatment is warm compresses and antibiotic.
What is a hordeolum and what is it most commonly cause by and what is the difference between external and internal hordeolums? Treatment?
A hordeolum is an acute development of a small, painful nodule or pustule within a gland in the upper or lower eye which is often caused by Staphylococcus aureus.
An internal hordeola is caused by inflammation and infection of the meibomian gland, which a
Chalazion
Relatively painless, indurated lesion deep from the palpebral margin. Often secondary to a chronic inflammation of an internal hordeolum.
Treatment is warm compresses and refer if not improving.
Entropion vs. Ectropion
Entropion is when the lids and lashes are turned in secondary to scar tissue or a spasm of the orbicularis oculi muscles.
Ectropion is when the edge of the eyelid everts secondary to advanced age, trauma, infection or palsy of the facial nerve.
Treatment:
Viral Conjunctivitis
Viral conjunctivitis is characterized by the acute onset of unilateral or bilateral erythema of the conjunctiva, copious watery discharge and ipsilateral tender preauricular lymphadenopathy.
Etiology: Adenovirus type 3, 9, 19, usually transmitted by direc
Bacterial Conjuncitivitis
Bacterial conjunctivitis is characterized by the acute onset of copious, purulent discharge from both eyes that may cause a mild decrease in VA and discomfort. Eyes may be crusted shut upon awakening.
Etiology: Common pathogens: Strep pneumoniae, Staph au
Pinguecula
Pinguecula is an elevated, fleshy, yellowish conjunctival mass found on the sclera adjacent to the cornea
Etiology: chronic actinic exposure, repeated trauma, dry/windy conditions
Treatment: none necessary, unless cosmetic concern
Pterygium
Pterygium: slow growing thickening of the bulbar conjunctiva that is highly vascular triangle mass that grows from the nasal side toward cornea
Treatment: non necessary unless vision interference
Papilledema
Papilledema is defined as an increase in intracranial pressure.
Etiology: Many causes but may include malignant hypertension, hemorrhage strokes, acute subdural hematoma, pseudotumor cerebri
Exam: Disc appears swollen, margins are blurred with an oblitera
Blurred Vision: how to assess location of the lesion
Lesions anterior to the optic chiasm will affect only 1 eye.
Lesions at the optic chiasm will affect both eyes partially.
Lesions posterior to the optic chiasm will yield corresponding defects in both visual fields.
What are differential diagnoses for transient, gradual and sudden visual loss?
Transient vision loss: TIA, embolic (amaurosis fugax), temporal (giant cell) arteritis
Sudden vision loss: CRVO, CRAO, optic neuropathy, papillitis, retrobulbar neuritis, angle-closure glaucoma
Gradual vision loss: macular degeneration, tumors, cataracts,
What is amaurosis fugax?
Transient monocular vision loss likely due to a TIA
Strabismus
Strabismus is a condition in which binocular fixation is not present. Strabismus may occur in one eye or both. A corneal light reflex test will reveal misalignment (manifest or heterotropia strabismus). A cover-uncover test may reveal latent (heterophoria
Amblyopia
Amblyopia is reduced visual acuity not correctable by refractive means.
It may be caused by strabismus (commonly), uremia, toxins, lead, or other substances.
Icterus/Jaundice
Yellowing of the sclera secondary to retention of bilirubin
Blue or Cyanotic Sclera
Seen in infants with osteogenesis imperfecta/Ehlers Danlos syndrome