Opthomology
are evaluating a 24-year-old woman for bilateral eye pain. She describes red, itching, irritated eyelids for several weeks. She states she has had "several bouts" of similar symptoms over the last few years. Exam is consistent with blepharitis. She does not wear contacts, and she occasionally wears eye makeup. She denies any other infectious complaints. what is the TX?
Discuss good eye hygiene and eyelid scrubbing
A 64-year-old woman presents with acute onset of right eye pain and blurred vision, as well as nausea and vomiting. After physical examination and determination of elevated intraocular pressure, the emergency room physician starts treatment for acute angle closure glaucoma and consults an ophthalmologist. During treatment, what is the goal intraocular pressure?
<35 mmHg
contraction of the ciliary muscle to focus the lens, process by which the vertebrate eye changes optical power to maintain a clear image or focus on an object as its distance varies. Occurs as a consequence of a reduction in zonular tension induced by ciliary muscle contraction
Accommodation
trade name Diamox, diuretic, carbonic anhydrase inhibitor that is used for the medical treatment of glaucoma, In the eye this results in a reduction in aqueous humour SE's is Steven Johnson syndrome, nearsightedness, angle closure glaucoma due to ciliary body swelling
Acetazolamide
A 72-year-old African-American man is brought to the emergency room with a sudden onset of excruciating pain and vision loss in the right eye. He is experiencing nausea, and he had been vomiting in the ambulance. The upper eyelid is swollen; there is circumcorneal injection and lacrimation. Upon examination with the slit lamp, you see the cornea is swollen and steamy; the anterior chamber is shallow, and the pupil is fixed and dilated. The intraocular pressure is 20 mm Hg on the left side and 60 mm Hg on the right side. What immediate action should be taken?
Administration of oral glycerin
A 25-year-old malepresents with 'acute red eyes' with copious watery discharge. He also notes some aversion to bright light. While rubbing his left eye, he describes a sensation of a 'gritty' foreign body. He denies any visual disturbance or pain. On physical exam, the conjunctiva of both eyes are injected and mildly edematous. The remainder of the exam is all within normal limits. What is the most likely diagnosis?
Allergic conjunctivitis
will have unequal light distribution on the pupil/ diplopia, decreased vision in an eye that otherwise appears normal, or out of proportion to associated structural problems of the eye; there is much more damage to or impact on vision in that eye than is predicted. Experience related visual disorders, most notably poor depth perception. May suffer from poor spatial acuity, low sensitivity to contrast motion, also have problems of binocular vision
Amblyopia
33-year-old man presents with acute left eye pain. He was working in his garage on a woodworking project, and as he hammered in a nail, he felt that something hit him in the left eye. On examination, you note that the left pupil has a teardrop appearance. what is the first imaging of choice for this PT?
An X-ray of the orbits ( clinical picture is suggestive of an intraocular foreign body or penetrating injury to the eye. This is commonly seen in individuals with a history of pounding on metal or using grinding equipment. The patient may give a history of "something hitting my eye" or "something was pulled out of my eye. His pupil is teardrop shaped, indicating penetration of the globe. An X-ray or CT scan of the orbit should be ordered to rule out radiopaque foreign bodies. Referral to an ophthalmologist is recommended.)
also known as Iopidine is a sympathomimetic used in glaucoma therapy. It is a α2-adrenergic agonist and a weak alpha-1 adrenergic receptor agonist. Topical _________________ is administered for the prevention and treatment of postsurgical intraocular pressure elevation and for short-term adjunctive therapy in patients on maximally tolerated medical therapy who require additional redirection of intraocular pressure. One drop is usually added one hour prior to laser eye surgery and another drop is given after the procedure is complete. Patients on maximally tolerated medical therapy who require additional reduction. May be useful in the diagnosis of Horner's syndrome. It causes a reversal of anisocoria that is characteristic of Horner's. It can also decrease IOP in glaucoma patients by increasing trabecular outflow, in a similar way to clonidine but without the cardiovascular side effects.
Apraclonidine
transparent, gelatinous fluid similar to plasma, but containing low protein concentrations. It is secreted from the ciliary epithelium, a structure supporting the lens. It is located in the anterior and posterior chambers of the eye, the space between the lens and the cornea. Maintains the intraocular pressure and inflates the globe of the eye. • Provides nutrition (e.g. amino acids and glucose) for the avascular ocular tissues; posterior cornea, trabecular meshwork, lens, and anterior vitreous. • May serve to transport ascorbate in the anterior segment to act as an antioxidant agent. • Presence of immunoglobulins indicate a role in immune response to defend against pathogens. • Provides inflation for expansion of the cornea and thus increased protection against dust, wind, pollen grains and some pathogens. • for refractive index.
Aqueous humor
where rays that propagate in two perpendicular planes have different focus. Ophthalmic is a refraction error of the eye in which there is a difference in degree of refraction in different meridians. It is typically characterized by an aspherical, non-figure of revolution cornea in which the corneal profile slope and refractive power in one meridian is less than that of the perpendicular axis. It causes difficulties in seeing fine detail. can be often corrected by glasses with a lens that has different radii of curvature in different planes (a cylindrical lens), contact lenses, or refractive surgery.
Astigmatism
severe anterior uveitis- to relieve pain by immobilizing the iris, to prevent adhesion of the iris to the anterior lens capsule (posterior synechia), which can lead to iris bombe and elevated IOP, to stabilize the blood-aqueous barrier and help prevent further protein leakage (flare)
Atropine
MC malignant tumor of the eyelids is
BCC
MC cause of isolate 7th nerve palsy, may have viral prodrome followed by ear pain, decreased tearing or taste, facial numbness, progresses over 10 days, rarely bilateral, family disposition
Bell's palsy
least effect on B2 receptors, it is B1 selective, selective for beta1 receptors, it typically has fewer systemic side effects than non-selective beta-blockers, for example, not causing bronchospasm (mediated by beta2 receptors) as timolol may. Also shows greater affininty for beta1 receptors than metoprolol. In addition to its effect on the heart, It reduces the pressure within the eye (intraocular pressure). This effect is thought to be caused by reducing the production of the liquid (which is called the aqueous humor) within the eye.
Betaxolol
74-year-old man presents with a 1 ½-hour history of severe pain and blurred vision in his left eye. Upon examination, his left eye is erythematous with a steamy cornea and a nonreactive, dilated pupil. An ophthalmologic consult is ordered, and tonometry is completed, revealing an elevated intraocular pressure and a confirmed diagnosis of acute angle-closure glaucoma. What will be the definitive treatment for this patient?
Bilateral laser peripheral iridotomy
66-year-old man presents with sudden onset of brief episodes of blindness in his right eye, with complete recovery before the next episode. The event is described as a shade coming down across his field of vision, and it is not painful. what is the most likely origin of the emboli?
Carotid stenosis
X-ray plate is angled at 20° to orbitomeatal line. The rays pass from behind the head and are perpendicular to radiographic plate. It is commonly used to get better view of frontal sinuses.
Caldwell view
A 78-year-old Caucasian male presents with unilateral painless loss of vision in the right eye of 3 hours duration. Examination reveals an elderly gentleman who is anxious but in no acute distress. Visual acuity is light perception only in the right eye and 20/30 in the left eye. Pupillary examination is significant for an afferent pupillary defect on the right side. Penlight examination of the eyes is otherwise unremarkable. Retinal examination of the right eye reveals a cherry-red spot. Retinal examination of the left eye is unremarkable. What disease process most likely accounts for the patient's presentation??
Central retinal artery occlusion
supplies blood to the outer retinal layer, vascular layer of the eye, containing connective tissue, and lying between the retina and the sclera. The human _______ is thickest at the far extreme rear of the eye, while in the outlying areas it narrows. The _____ provides oxygen and nourishment to the outer layers of the retina. Along with the ciliary body and iris, the _______ forms the uveal tract.
Choroid
white female comes into the evening clinic with complaint of red eyes with a sticky discharge. Her eye feels irritated, the pain is mild. She tells you she shared towels with her boyfriend who had a red eye. She asks you if you think her boyfriend gave her an infection. What is your working diagnosis?
Conjunctivitis
the transparent front part of the eye that covers the iris, pupil, and anterior chamber. The ________, with the anterior chamber and lens, refracts light, with the cornea accounting for approximately two-thirds of the eye's total optical power. contributes most of the eye's focusing power, its focus is fixed. The curvature of the lens, on the other hand, can be adjusted to "tune" the focus depending upon the object's distance. Layer with most significant component of the total refractive power of the eye is the epithelial layer.
Cornea
severe pain and photophobia, hx of trauma, TX is bacitraicin-polymixin ointment and cyclopentalate and NSAIDs
Corneal Abrasion
paralysis of the ciliary muscle of the eye, resulting in a loss of accommodation. This class of drugs are generally muscarinic receptor blockers. These include atropine, cyclopentolate, homatropine, scopolamine and tropicamide. They are indicated for use in __________ refraction (to paralyze the ciliary muscle in order to determine the true refractive error of the eye) and the treatment of uveitis. All ___________ are also mydriatic (pupil dilating) agents and are used as such during eye examination to better visualize the retina.
Cyclopegics
25-year-old man presents to your office after a skiing vacation. He is complaining about sensitivity to light and eye pain bilaterally that rates 8 out of 10. In order to better evaluate this patient you instill fluorescein and perform a slit lamp exam. You notice that both corneas exhibit diffuse punctuation. What would you prescribe for this patient?
Cyclopentolate drops
32-year-old woman presents with a 3-day history of irritation, burning, itching, and redness of both eyelids. She denies fever, visual changes, and photophobia. On physical examination, you note the presence of scales clinging to the eyelids bilaterally. what is the TX?
Daily cleaning with a damp cotton applicator and baby shampoo
can be caused by Bell's palsy/ 7th nerve palsy, lower eyelid turns outwards. It is one of the notable aspects of newborns exhibiting congenital Harlequin-type ichthyosis, but it can occur due to any weakening of tissue of the lower eyelid. The condition can be repaired surgically.
Ectropion
A 35-year-old female presents to her primary care provider's office with the chief complaint of purulent drainage and erythema of her right eye for the past 24 hours. After a brief physical examination, her provider would like to take cultures of the drainage and start her on a medication prophylactically that would cover the most common bacterial causes of conjunctivitis (including sexually transmitted diseases). Question Cross What medication, in either an oral or topical form, would she most likely be started on?
Erythromycin ( if trying to cover all bacterial etiologies of conjunctivitis, then erythromycin can be given in the oral form in order to include good coverage for both gonococcal conjunctivitis and chlamydial conjunctivitis. If the erythromycin ophthalmic ointment were to be prescribed in a patient with a sexually transmitted disease bacterial conjunctivitis, they may still see partial or complete resolution of symptoms. Therefore, erythromycin in either the topical or oral form would have a good chance of treating any bacterial cause of conjunctivitis until the culture results confirm the etiologic agent.)
form of strabismus, or "squint," in which one or both eyes turns inward. The condition can be constantly present, or occur intermittently, and can give the affected individual a "cross-eyed" appearance. It is sometimes erroneously called "lazy eye," which describes the condition of amblyopia—a reduction in vision of one or both eyes that is not the result of any pathological lesion of the visual pathway and cannot be resolved by the use of corrective lenses.
Esotropia
bulging of the eye anteriorly out of the orbit. Can be either bilateral (as is often seen in Graves' disease) or unilateral (as is often seen in an orbital tumor). In the case of Graves' disease, the displacement of the eye is due to abnormal connective tissue deposition in the orbit and extraocular muscles which can be visualized by CT or MRI. If left untreated, it can cause the eyelids to fail to close during sleep leading to corneal dryness and damage. Protrusion of the globe greater than 18 mm. can be caused by Mucormycosis
Exophthalmos- Proptosis
a form of strabismus where the eyes are deviated outward. People with ________ often experience crossed diplopia. Intermittent ________ is a fairly common condition.
Extropia
A white male comes into the ER with the complaint of pain in his right eye. He was whittling and felt like something went into his eye. This happened four hours ago. He has washed his eye with water, but it still feels funny. What is your working diagnosis??
FB
25-year-old man has been enjoying 3 days of skiing in Taos, New Mexico. After a few hours of sleep the 3rd night, he awakens with severe bilateral eye pain associated with lacrimation and photophobia. What will be most helpful in confirming your suspected diagnosis?
Fluorescein staining
Flame-shaped hemorrhages are indicative of
HTN
decreased vision or blindness (anopsia) in half the visual field of one or both eyes, usually on one side of the vertical midline. The most common causes of this damage are stroke, brain tumor, and trauma.
Hemianopsia
33-year-old man presents with a 1-day history of a painful left upper eyelid. He denies any change in vision, discharge, trauma, or foreign body. The pain started after the patient was cleaning out the garage. On physical exam, the visual acuity is OD/OS/OU = 20/20. The lateral aspect of the left upper eyelid is swollen, erythematic, and tender to palpation. The rest of the eye exam is normal.
Hordeolum
35-year-old woman presents with a painful swelling of her left eyelid. On physical exam, there is tenderness to palpation and erythematous swelling present on the lid margin involving the eyelashes.
Hordeolum
43-year-old woman presents to a walk-in clinic with a complaint of a painful, red lump on her left eyelid. Examination shows an oozing erythematous pustule surrounded by hyperemia edema. What is the most likely diagnosis?
Hordeolum
An 8-year-old child is brought to your office because of swelling of the left upper eyelid; the swelling is associated with redness and tolerable pain. No fever is noted. Physical examination shows a localized swelling and redness on the upper middle lid of the left eye; there is slight tenderness on palpation. Vital signs are within normal limits. What is the most likely diagnosis?
Hordeolum
eyeball is too short or the lens cannot become round enough), causing difficulty focusing on near objects. Farsightedness is the result of the visual image being focused behind the retina rather than directly on it. It is mainly cause by two reasons- • Low converging power of eye lens because of weak action of ciliary muscles. • Eyeball being too short because of which the distance between eye lens and retina decreases. Farsightedness is often present from birth, but children have a very flexible eye lens, which helps make up for the problem. As aging occurs, glasses or contact lenses may be required to correct the vision. Farsightedness is hereditary.
Hyperopia
known as the lacrimal canals or lacrimal ducts, are the small channels in each eyelid that commence at minute orifices, termed puncta lacrimation, on the summits of the papillae lacrimales, seen on the margins of the lids at the lateral extremity of the lacus lacrimalis. • The superior duct, the smaller and shorter of the two, at first ascends, then bends at an acute angle, and passes medial ward and downward to the lacrimal sac. • The inferior duct at first descends, and then runs almost horizontally to the lacrimal sac.
Inferior canaliculus
is a thin, narrow muscle placed near the anterior margin of the floor of the orbit. Is an extraocular muscle, and is attached to the maxillary bone (origin) and the posterior, inferior, lateral surface of the eye (insertion). The ____________is innervated by the inferior branch of the oculomotor nerve.
Inferior oblique- or obliquus oculi inferior
As with most of the muscles of the orbit, it is innervated by the oculomotor nerve (Cranial Nerve III). It depresses, adducts, and helps extort (rotate laterally) the eye. This muscle is the only muscle that is capable of depressing the pupil when it is in a fully abducted position.
Inferior rectus
thin, circular structure in the eye, responsible for controlling the diameter and size of the pupil and thus the amount of light reaching the retina. It gives the eye its color
Iris
itchy, FB sensation, pinpoint hemorrhages, intraepithelial microcytosis, may develop a pseudomembrane, HX of recent URI, MC cause is adenovirus: wash hands, topical antihistamines, Eye clinics and swimming pools are a source of infection
Keratoconjunctivitis/ viral
paired almond-shaped glands, one for each eye, that secrete the aqueous layer of the tear film. They are situated in the upper, outer portion of each orbit, Inflammation of the ________________is called dacryoadenitis. The _________________produces tears which then flow into canals that lead to the lacrimal sac. From this sac, the tears drain through the lacrimal duct into the nose.
Lacrimal gland
Dacryocystitis is infection of the ____________, upper dilated end of the nasolacrimal duct, and is lodged in a deep groove formed by the lacrimal bone and frontal process of the maxilla. It connects the lacrimal canaliculi, which drain tears from the eye's surface, and the nasolacrimal duct, which conveys this fluid into the nasal cavity. Mainly for high amounts of tears, in which the __________pumps inward and outward driven by the orbicularis muscle during blinking.
Lacrimal sac
bring the pupil away from the midline of the body, originates at the lateral part of the annulus of Zinn, also known as the annular tendon or common tendinous ring, and inserts into the temporal side of the eyeball, It is the only muscle innervated by the abducens nerve, cranial nerve VI, sixth nerve palsy, also known as abducens nerve palsy, is a neurological defect that results from a damaged or impaired abducens nerve. This defect can result in horizontal double vision and reduced lateral movement. Proper function of the __________is tested clinically by asking the patient to look laterally.
Lateral rectus
70-year-old man presents with paralytic strabismus with maximal esotropia as he gazes to the left. Question Cross Which of the following nerves is most likely affected in this case?
Left sixth cranial nerve
biconvex structure in the eye that, along with the cornea, helps to refract light to be focused on the retina. By changing shape, functions to change the focal distance of the eye so that it can focus on objects at various distances, thus allowing a sharp real image of the object of interest to be formed on the retina. This adjustment of the ____ is known as accommodation. Separates the anterior from the vitreous chamber.
Lens
old, chronic deterioration of central vision in one or both eyes, distortion of size of images, no pain or redness, macular abnormalities seen on exam (drusen), white and female family hx, smoking
Macular Degeneration
constriction of the pupil
Miosis
(class of meds) agent that induces dilation of the pupil. Drugs such as tropicamide are used in medicine to permit examination of the retina and other deep structures of the eye, and also to reduce painful ciliary muscle spasm. Phenylephrine is used if strong mydriasis is needed for a surgical intervention. One effect of administration of a _________ is intolerance to bright light (photophobia). Also used as a diagnostic test for Horner's Syndrome.
Mydriatics
predisposes PT to retinal detachment Condition of the eye where the light that comes in does not directly focus on the retina but in front of it, causing the image that one sees when looking at a distant object to be out of focus, but in focus when looking at a close object. Nearsightedness
Myopia
It is a sympathomimetic agent with marked alpha adrenergic activity. It is a vasoconstrictor with a rapid action in reducing swelling when applied to mucous membrane. It acts on alpha-receptors in the arterioles of the conjunctiva to produce constriction, resulting in decreased congestion. It is an active ingredient in several over-the-counter formulations including Clear Eyes and Naphcon eye drops, Extended use may cause rhinitis medicamentosa, a condition of rebound nasal congestion.
Naphazoline
sometimes called the tear duct) carries tears from the lacrimal sac into the nasal cavity.
Nasolacrimal duct
serrated junction between the retina and the ciliary body. This junction marks the transition from the simple non-photosensitive area of the retina to the complex, multi-layered photosensitive region. In this region the pigmented epithelium of the retina transitions into the outer pigmented epithelium of the ciliary body and the inner portion of the retina transitions into the non-pigmented epithelium of the cilia.
Ora serrata
optic disk swelling due to raised ICP is usually bilateral and produces enlargement of the blind spot without loss of VA, if chronic weight loss acetazolamide, and if not effective a shunt
Papilledema
parasympathomimetic alkaloid, specifically, a reversible cholinesterase inhibitor. It occurs naturally in the Calabar bean, has a miotic function, causing pupillary constriction. It is useful in treating mydriasis. Also increases outflow of the aqueous humor in the eye, making it useful in the treatment of glaucoma.Recently, has been proposed as antidote for intoxication with gamma hydroxybutyrate
Physostigmine
A 32-year-old woman with a past medical history of multiple environmental allergies presents with bilateral ocular pruritis, eye redness, and excessive tearing over the last several days. She notes associated nasal congestion. She states that these symptoms are predictable, occurring at approximately the same time every year. She has had these symptoms for many years, and over-the-counter medications are not helpful. She denies ocular trauma, fever, chills, swollen glands, otalgia, otorrhea, headache, and sore throat. She further denies shortness of breath, cough, and chest pain. Her physical exam is remarkable for bilateral conjunctival erythema and chemosis, violaceous mucosal turbinates in the nasal cavity, and small nasal polyps. What health maintenance strategy is correct regarding this patient? 1 Warm compresses applied to the eyes will reverse ocular symptoms. 2 Intranasal steroids will resolve symptoms immediately. 3 Pillow and mattress covers, air purifiers, and dust filters should be purchased 4 Over-the-counter antihistamines typically cause increased alertness and energy. 5 This patient should be immediately referred for surgical removal of her nasal polyps.
Pillow and mattress covers, air purifiers, and dust filters should be purchased.
can precipitate an acute glaucoma in a PT with a narrow anterior chamber, no effect on IOP over 60. It is a non-selective muscarinic receptor agonist in the parasympathetic nervous system, which acts therapeutically at the muscarinic acetylcholine receptor M3 due to its topical application, e.g., in glaucoma and xerostomia. Treatment of chronic open-angle glaucoma and acute angle-closure glaucoma for over 100 years. action facilitates the rate that aqueous humor leaves the eye to decrease intraocular pressure. Eye drops can result in brow ache and chronic use in miosis.
Pilocarpine
Yellow elevated conjunctival nodule, more commonly on the nasal side, does not cross the limbis of the iris
Pinguecula
sudden onset of decreased vision and increasing eye pain after a surgical procedure, hypopyon, fibrin, and sever anterior chamber reaction, decreased red reflex, MC is staph
Post-op enopthalmitis
progressively diminished ability to focus on near objects. The first signs of it is - eyestrain, difficulty seeing in dim light, problems focusing on small objects and/or fine print - are usually first noticed between the ages of 40 and 50. Research evidence most strongly supports a loss of elasticity of the crystalline lens, although changes in the lens's curvature from continual growth and loss of power of the ciliary muscles
Presbyopia
Fleshy triangular encroachment of the conjunctiva onto the nasal side of the cornea associated with prolonged wind/ sun exposure, indication for surgery is when it grows and threatens the vision, crosses the limbus of the iris
Ptergium
class of drugs that increases outflow, wider use of is limited by unwanted side effects and their abortive potential. Used in the management of open-angle glaucoma. They reduce intra-ocular pressure by enhancing uveoscleral outflow and may also have some effect on the trabecular meshwork as well. Latanoprost, travoprost, unoprostone and bimatoprost are examples of _______________________used in the management of open-angle glaucoma. Notable side effect is a possible darkening of iris color.
Prostaglandin analogs
A 30-year-old woman presents to the emergency room at 7 am with severe pain and swelling of her right eye. She was awakened early the previous evening due to the discomfort and swelling of the surrounding conjunctiva. She found it difficult to sleep due to the discomfort. She planned on going to work, but the swelling had closed her eye shut, and she developed excruciating pain in the eye that radiated internally. The patient does not recollect any previous trauma or injury to the eye. She uses contact lenses, but they were not in use due to the condition of her eye. The contact lenses were stored in a small pillbox container with some fluid that she later described as tap water. She ran out of sterile cleaning and soaking solution for the contact lenses, so she has been using tap water as a substitute for approximately 5 days. She frequently sleeps with her contacts in. The patient is afebrile. Pulse is 70/min, and blood pressure is 135/80 mm Hg. Lungs are clear, and there is no evidence of lymphadenopathy. The eye has a profound conjunctivitis that is acute and follicular. Purulent drainage is present. The acute nature of the conjunctivitis requires an ophthalmologist consult. The ophthalmologist obtains ocular fluid for culture and Gram stain. CBC results are unremarkable. Prompt and aggressive therapy is initiated. What is the most likely organism causing this acute eye threatening infection?
Pseudomonas aeruginosa (Pseudomonas aeruginosa is a Gram-negative rod; it is a non-lactose fermenting, oxidase-positive motile bacteria. Growth on MacConkey agar is usually characterized by the production of a "grape-like" smell. A blue-green color, due to the production of the diffusible fluorescent pigments pyoverdin and pyocyanin, is characteristic of the colonies growing on MacConkey. Pseudomonas aeruginosa is a very common opportunistic source of human infections, especially in the hospital setting. Pathogenesis is due to its minimal nutritional requirements, relative resistance to antibiotics, and a host of other invasive and toxicogenic substances that it produces. It can cause a keratitis that is rapid in its development. The infection is usually the result of a previous injury to the eye, which causes an interruption in the epithelial surface and allows bacterial invasion of the underlying stroma. It can also be caused by contact lenses. Fever is usually absent, and leukocytosis is absent or minimal. The infection can lead to corneal ulceration, resulting in the rapid loss of ocular function; therefore, these infections need to be approached as a medical emergency. Scrapings from the floor of the ulcer exhibiting Gram-negative rods are strongly indicative of Pseudomonas aeruginosa and should necessitate treatment. Immediate initiation of combined topical and subconjunctival therapy with an aminoglycoside antibiotic such as gentamicin or tobramycin is advised. Topical steroids are sometimes used to reduce ocular inflammation.)
light-sensitive layer of tissue, lining the inner surface of the eye. layered structure with several layers of neurons interconnected by synapses. The only neurons that are directly sensitive to light are the photoreceptor cells. These are mainly of two types: the rods and cones. Rods function mainly in dim light and provide black-and-white vision, while cones support daytime vision and the perception of color. A third, much rarer type of photoreceptor, the intrinsically photosensitive ganglion cell, is important for reflexive responses to bright daylight.
Retina
white of the eye. forms the posterior five-sixths of the connective tissue coat of the globe. It is continuous with the dura mater and the cornea, and maintains the shape of the globe, offering resistance to internal and external forces, and provides an attachment for the extraocular muscle insertions. It is perforated by many nerves and vessels passing through the posterior scleral foramen, the hole that is formed by the optic nerve.
Sclera
Dialates the eyes for several days and is often used for very large painful abrasions. will cause dialation/ mydriasis used to widen the pupils for eye examination or eye surgery. It is also used to decrease pain and swelling from an inflammation of the eye (iridocyclitis). It belongs to a class of drugs known as anticholinergics. It works by blocking the effects of a certain natural chemical (acetylcholine) on certain eye muscles, causing relaxation of these muscles. This effect causes the pupil to widen and the lens to temporarily lose the ability to focus. It decreases pain in eye inflammation by relaxing the eye muscles.
Scopolamine .25% drops
abducts, depresses and internally rotates the eye. It is the only extraocular muscle innervated by the trochlear nerve (the fourth cranial nerve).
Superior oblique
aminoglycoside antibiotic derived from Streptomyces tenebrarius and used to treat various types of bacterial infections, particularly Gram-negative infections. It is especially effective against species of Pseudomonas, it is ototoxic, topically though it has low systemic absorbancy
Tobramycin
48-year-old Caucasian man presents with acute onset of blurring of vision and severe pain in the left eye that began 1/2 hour ago. He notes seeing halos with his left eye; he is also experiencing nausea and vomiting; those symptoms started at the same time as the pain. The patient reports that he was relaxing on his porch when the pain started. His vital signs are: temp. 36.9 C, pulse 90/min, BP 130/90 mm Hg, and resp. 20/min. Physical examination reveals a shallow anterior chamber, a hazy cornea, a fixed, moderately dilated pupil, and ciliary injection. What would be the next step in the management of this patient?
Tonometry
area of tissue in the eye located around the base of the cornea, near the ciliary body, and is responsible for draining the aqueous humor from the eye via the anterior chamber (the chamber on the front of the eye covered by the cornea). The tissue is spongy and lined by trabeculocytes; it allows fluid to drain into a set of tubes called Schlemm's canal flowing into the blood system. The __________________is responsible for most of the outflow of aqueous humor.
Trabecular meshwork
ophthalmic solution is a topical medication used for controlling the progression of glaucoma or ocular hypertension, by reducing intraocular pressure. It is a synthetic prostaglandin analog (or more specifically, an analog of prostaglandin F2α) that works by increasing the outflow of aqueous fluid from the eyes.
Travoprost
they function to collect tears produced by the lacrimal glands. The fluid is conveyed through the lacrimal canaliculi to the lacrimal sac, and thence via the nasolacrimal duct to the inner nose.
Upper lacrimal punctum
clear gel that fills the space between the lens and the retina of the eyeball. Floaters are generally harmless, but the sudden onset of recurring floaters may signify a posterior vitreous detachment (PVD) or other diseases of the eye.
Vitreous humor
good for orbital blowout fracture because it shows blood/ fluid level in the maxillary sinuses on the side of trauma, X-ray beam is angled at 45° to the orbitomeatal line. The rays pass from behind the head and are perpendicular to the radiographic plate. It is commonly used to get a better view of the maxillary sinuses. A radiographic frontal view of the maxillary sinuses, orbits, nasal structures and zygomas; permits direct comparison of the sides
Waters view
a ring of fibrous strands connecting the ciliary body with the crystalline lens of the eye. The number of zonules present in a person appears to decrease with age
Zinns membrane
MC eye disease is
conjunctivitis
used for newborns to prevent GC, used for crazy glue in the eye. Macrolide group of antibiotics. It is basic and readily forms a salt when combined with an acid. For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by organisms susceptible to erythromycin. For prophylaxis of ophthalmic neonatorum due to N. gonorrhoeaeor C. trachomatis. The effectiveness of erythromycin in the prevention of ophthalmia caused by penicillinase-producing N. gonorrheaeis not established. For infants born to mothers with clinically apparent gonorrhea, intravenous or intramuscular injections of aqueous crystalline penicillin G should be given; a single dose of 50,000 units for term infants or 20,000 units for infants of low birth weight. Topical prophylaxis alone is inadequate for these infants.
erythromycin
eyelid edema, erythema, maybe mild fever, no proptosis or restriction of extra-ocular motion, no pain with eye movement, may not be able to open the eye because of the swelling, MC caused by trauma or adjacent infection staph and strep, H influenza in non-immunized children, TX with oral ABX
periorbital cellulitis
72-year-old woman presents complaining of a severe unilateral headache, jaw pain, and scalp tenderness. The patient states the headache is of a piercing quality and her jaw hurts only when she chews and feels better after she stops chewing a few minutes later. You examine the patient and cannot appreciate any pulsation of the temporal artery on the same side of her headache. You decide to consult a specialist. While waiting, you prescribe prednisone. Why is prednisone prescribed in this case?
risk of blindness with GCA
cells and flare in the anterior chamber, ciliary flush, keratic precipitates, Bilateral alternating anterior ________is very characteristic of HLA-B27 ______, can be cause by medication- Rifabutin, Cause in infants- TORCH, retinoblastoma Children- JIA, Toxocariasis, Toxoplassmosis Young adults- HLA-B27, Fuchs, Elderly- Lymphoma Female- JIA, SLE Male- Ank spon, reactive arthritis White- HLA-B27 Black- Sarcoidosis
Acute Iritis- Iritis / Uveitis
old age, farsighted, rapid onset of pain and profound vision loss with halos around lights, red eye, cloudy cornea, dilated pupil, hardy aye on palpation, occurs with pre-existing narrow anterior chamber angle, RF are shallow anterior chamber (associated with far sightedness or short stature or both), enlargement of the crystalline lens, inheritance, Asians, precipitated by pupillary dilation, initial TX is 500mg IV acetazolamide then 250mg oral 4X daily, once pressures fall then topical 4% pilocarpine is used to reverse the angle closure. PT should undergo prophylactic iridotomy in unaffected eye
Acute angle closure glaucoma
40 y/o presents to ER with severe pain in his left eye, decreased vision, nausea, and abdominal pain. On examination, the patient's left pupil is moderately dilated and nonreactive. The cornea is "steamy" in appearance and generally the eye is red. What do you suspect is the cause?
Acute angle-closure glaucoma
A 64-year-old Asian man presents with a 1-hour history of severe right eye pain that started while he was watching a movie at the theater. He notes right eye "blurred vision and seeing halos around lights". He denies loss of vision, trauma, discharge, and any symptoms in left eye. Last eye exam was 6 months ago, which resulted in new glasses. Past medical history is negative, and the patient denies any allergies. On physical exam, visual acuity is OS 20/25, OD is 20/70, and OU is 20/40. Pupil on right eye is 7 mm, and left eye is 3 mm. Right pupil was non-reactive to light; left pupil was reactive to light. Right cornea was steamy in appearance, and left cornea was clear.
Acute angle-closure glaucoma
3-day-old girl presents with rapidly progressing bilateral conjunctivitis with white discharge. She was born full term via precipitous vaginal delivery, and her mother had no prenatal care. On exam she is alert and active. The eye discharge is purulent, and she has bilateral eyelid edema. what is the TX
Admit to the hospital for IV antibiotics and evaluation. (Ophthalmia neonatorum is a form of conjunctivitis occurring in infants younger than 4 weeks. The usual incubation period is 2 - 5 days for N. gonorrhoeae and 5 - 14 days for C. trachomatis. Conjunctivitis due to silver nitrate drops usually occurs within 6 - 12 hours after birth. Due to the timing and severity of the conjunctivitis, in conjunction with the fact that the mother had no prenatal care, it is possible that this infant has gonococcal conjunctivitis. Giving an IM dose of ceftriaxone is not enough. Due to the possibility of blindness and gonococcal meningitis or sepsis, the infant should be monitored closely. She should be admitted to the hospital for eye, blood, and possibly CSF cultures. Tests for other infections such as C. trachomatis, syphilis, hepatitis B, and HIV should be performed. This infant should be treated with ceftriaxone with frequent eye flushes.)
bilateral itchy eyes, watery discharge, HX of allergies, bilateral, , chemosis and red edematous eyelids, conjunctival papillae, no pre-auricular node, eliminate the inciting agent, cool compressed, artificial tears, oral antihistamine, shiners, patanol
Allergic conjunctivitis
Transient monocular vision loss caused by retinal embolus from ipsilateral carotid disease or heart, described as curtain passing vertically across the eye with complete vision loss lasting a few minutes, immediate TX with oral aspirin until the cause can be determined, if 2 or more cases In the last week then admit,
Amarausis fugax
are indicative of nonproliferative diabetic retinopathy, which is usually seen 10 to 20 years after the onset of diabetes. Nonproliferative retinopathy does not always progress to proliferative retinopathy, but if it becomes extensive, it can result in retinal ischemia, which increases the likelihood of proliferative disease.
Blot hemorrhages, cotton wool spots, and microaneurysms
bilateral inflammatory condition of the lid margins may be seborrheic and involve the scalp, eyebrows, and ears. Anterior is the eyelid skin and eyelashes, posterior is the meibomian glands. Itching burning, mild pain, FB sensation, crusting around the eyes on awakening, crusty red thickened eyelid margins, (opposite of dry eyes that is worse later in the day), TX id lid hygiene with baby shampoo and warm compresses
Blepharitis
3-year-old boy presents after waking up with his eyelids glued together. His mother states that he has been rubbing his eyes constantly. The medical history is unremarkable, and the patient had not been sick before. Upon examination, redness of the lid margin, edema, conjunctival irritation, and loss of lashes can be seen. There are also some scales on the lid margin that can be removed easily. What is the most likely diagnosis?
Blepharitis
Question Cross Highlights A client comes into the clinic with a complaint of flaking and scaling around her lashes, along with itching and burning sensation, occurring over the past year. She has also noted her lid margins are red, and some of her lashes are missing. Her history is significant for seborrheic dermatitis of the scalp, eyebrows, and external ears, and diabetes. What is the most likely diagnosis?
Blepharitis
infection of the lacrimal sac from obstruction of the nasolacrimal DUCT system, MCC is staph A, pain swelling and redness of the tear sac area, TX is systemic ABX and eventually a ryocystorhinostomy (removal of the blockage). Chronic is caused by candida albicans.
Dacryocystitis
Common congenital ophthalmic infection
CMV, 90% are asymptomatic at birth
MC cause/ RF is age relate changes, glare from oncoming headlights while driving at night, reduced color perception, opacification of the crystalline lens, blurred view of the retina, other causes, diabetes, atopic dermatitis, trauma, steroids, mitotic, antipsychotics/ phenothiazine's, small white iridescent changes seen in the presence of tetany is caused by hypocalcemia, Wilsons disease, Christmas tree cataract is myotonic dystrophy, downs syndrome, TX is surgery to improve vision, trial of mydriasis in PTs who wish to skip surgery (scopolamine), retina will be difficult to visualize on exam, when visual impairment is present they are a surgical candidate
Cataracts
type of blood vessel malformation or hemangioma, where a collection of dilated blood vessels form a tumor. Because of this malformation, blood flow through the cavities, or caverns, is slow. Additionally, the cells that form the vessels do not form the necessary junctions with surrounding cells and the structural support from the smooth muscle is hindered causing leakage into the surrounding tissue. often described as raspberry like because of the bubble-like caverns.
Cavernosus hemangioma
sudden monocular vision loss, no pain or redness, widespread or sectorial retinal swelling, if PT is over 50 consider GCA, VA is reduced to finger counting or worse, visual field is restricted to island of vision in the temporal field, ophthalmoscopy reveals pallid swelling of the retina with a cherry red spot at the fovea, the retinal arteries are attenuated and box car segmentation of blood in the veins may be seen, when swelling subsides in 4-6 weeks it leaves a pale optic disk, TX is high concentration O2, IV acetazolamide, anterior chamber paracentisis and consider thrombolytics, IF GCA is considered then high dose corticosteroids, retinal whitening, narrow arteriols and white stuff
Central arterial occlusion
An 84-year-old man presents to the emergency room with 2.5-hour history of painless, progressive vision loss in his right eye, which began while he was reading. He denies any other symptoms. Past medical history is positive for hypertension and a cardiac dysrhythmia. Physical exam findings include a BP of 180/110; other vital signs are normal, and the left eye non-reactive to light. Marcus Gunn pupil (afferent pupillary defect) is seen; funduscopic exam reveals a pale retina with a red spot. The rest of the physical exam is normal. What is the most likely cause of vision loss in this patient?
Central retinal artery occlusion
sudden monocular loss of vision, no pain or redness, widespread or sectorial retinal hemorrhages, commonly noticed upon waking, also seen is retinal vein dilation/ tortuosity/ retinal cotton wool spots/ optic disc swelling, check blood pressure in all PTs, screen for diabetes/ HTN, hyperlipidemia/ and glaucoma, in young PTs consider Combined oral contraceptives, macular dysfunction
Central retinal vein occlusion
38-year-old man presents with a firm, painless bump on his left eyelid. On examination, you note a 5 mm mass within the tarsus of the left eye. The skin is freely movable over the mass. The remainder of the eye exam is unremarkable. What is most likely diagnosis?
Chalazion
A 14-year-old girl has had a small, slightly tender swelling in her left upper eyelid for 2 - 3 days that has gradually enlarged, becoming round and painless. There has not been any drainage, visual changes, or itching noted. She has been well otherwise. On exam, vitals are normal, extraocular muscles are intact, and pupils are equal and reactive to light. Her left upper eyelid eyelid has a 1.5 cm round, nontender, swollen mass that is mildly erythematous without any drainage. The underside of the lid is grayish-red. Based on these findings, what is the most likely diagnosis?
Chalazion
A 24-year-old man presents with a painless, localized swelling of his left lower eyelid; it has developed over a period of weeks. He is seeking medical attention because it is now producing a foreign body sensation in his left eye; it is also hindering his path of vision. On physical examination, his visual acuity is normal; there is no evidence of injection or discharge. You palpate, and you observe a nontender, localized nodule on the lower eyelid.
Chalazion
23-year-old woman presents with a 2-week history of left eye irritation. She insists that there is a foreign object lodged under her eyelid. There are no other symptoms. Physical examination is remarkable for unilateral conjunctivitis, which appears acute and follicular in presentation, and mucoid discharge. There is no detectable foreign object present under the eyelid. 4 weeks ago, the patient presented with abdominal discomfort and vaginal bleeding. A cervical culture was obtained, and a blood specimen was obtained for a CBC. No other remarkable findings were noted on her last visit. Cervical cultures came back negative. CBC and differential were within normal limits. She had previously denied any sexual activity. When questioned again, she reveals that she has been sexually active with 2 male sexual partners in the past 4 months. All routine cultures for both sites are negative for any significant organisms or pathogens, and Gram stain results are "NOS". The most likely diagnosis is inclusion conjunctivitis concurrent with cervicitis due to what disease?
Chlamydia trachomatis
bilateral conjunctivitis with moderate white discharge. He is acting normally, has no fever, and is feeding well. He was born full term via vaginal delivery without any complications.
Chlamydia trachomatis
A 73-year-old African American man presents for routine follow-up at a primary eye care clinic. He notes that he has been diagnosed with glaucoma and his ophthalmologist has started him on a topical carbonic anhydrase inhibitor (dorzolamide) in order to lower eye pressure by decreasing aqueous humor production. The site of action of this drug would most likely be
Ciliary body epithelium
22-year-old woman presents with a 1-day history of foreign body sensation in her right eye. She woke up with pain in the right eye, and she immediately had trouble opening her eye. She wears soft contact lenses and does not remember how long the last pair was in for. She removed her contact lenses the night before the pain started. There was no trauma. Visual acuity was 20/40 O.U. without corrective lenses, and extraocular movements were within normal limits. With fluorescein stain, a defect is noted; it is round and found at the center of the cornea. No foreign bodies are noted. what ist the TX?
Ciprofloxacin 0.3% solution (TX for pseudamonas)
MC cause is pseudomonas aeruginosa, overnight wear, and topical fluoroquinalones hourly day and night for at least first 48 hours,
Contact lens corneal ulceration
What is the primary purpose of pilocarpine administration?
Control of increased intraocular pressure
MC commonly caused by an infection, (can be non-infectious cause) infection of the corneal stroma that presents with pain, redness and photophobia, slit lamp exam shows staining corneal defect with hazy infiltrate, TX is hourly application of topical ABX ofloxacin or ciprofloxacin, cycloplege to relieve pain, optho w/ in 24 hours
Corneal Ulcer
inflammation of the lacrimal gland, unilateral pain, redness and swelling over the outer third of the upper eyelid with tearing or discharge, children and young adults, outer one third with erythema, swelling, and tenderness, ipsilateral preauricular lymphadenopathy and conjunctival chemosis, "S" shaped upper eyelid, fever, elevated WBCs, MC cause is inflammatory non-infectious, may be in response to viral illness (mumps, flu, chicken pox), if cause is unknown empiric TX with ABX
Dacryoadenitis
27-year-old woman presents with a 3-day history of left eye pain. The patient notes sensitivity to light, and she comments that her eye throbs in pain at night. On physical examination, you note a redness and loss of visual acuity. What would be an appropriate treatment for this patient?
Dexamethasone and homatropine ophthalmic drops (The clinical picture is suggestive of uveitis. Patients with uveitis usually note redness, pain, photophobia, and visual loss. Treatment is with topical steroids and a dilating agent to relieve the discomfort. There are multiple causes of uveitis, but it is primarily immunogenic.)
MC of vitreous hemorrhage, any retinal edema within 500um of the center of the fovea, hard exudates within 500um of the center of the fovea if associated with adjacent areas of retinal thickening, retinal edema >1 disc are in size and within 1 disk diameter of the center of the fovea , grid laser TX should be considered for PTs with significant macular edema, consider virectomy when vitreal hemorrhages is causing decreased vision, traction retinal detachment involving the macula, severe retinal neovascularization
Diabetic retinopathy
Which drug used in glaucoma therapy has a prolonged duration of action and can be administered relatively infrequently?
Echothiophate
A 32-year-old man presents to an urgent care center with complaints of swelling of his right eyelid along the lash line. He works in construction and needs to be able to use his eyes, so he came in for treatment promptly. He is quickly diagnosed with a hordeolum of the right eye. Assuming he does not have any allergies, what is the first line treatment??
Erythromycin ophthalmic ointment
16-year-old boy was at his team basketball practice when a team member forcefully jabbed his fingers into the 16-year-old's left eye while trying to block his shot. He felt sharp, blinding pain and has had much tearing. He was taken out of practice, ice applied, and sent to you for evaluation. Which examination should always be performed initially following direct eye trauma?
Evaluate visual acuity with corrected vision in place
A mother brought her otherwise healthy 12-month-old son to your attention because she noticed that he has crossed eyes that are different colors. His mother has been smoking for about 10 years, including during the pregnancy. She remembers that her brother died when he was 3 because he had a tumor in both his eyes. Physical exam reveals heterochromia iridis and leukocoria. What is the main risk factor for the condition of this child?
Heredity
will cross dermatomes, dendrites, do not use steroids, will increase viral replication
HSV dermatitis
acute infection of the oil gland at the lid margin, TX is warm compresses and erythromycin for 7-10 days, Painful staph abscess of the eyelid
Hordeolum- (external hordeolum)/ stye
Ptosis, Miosis, and anhidrosis. Anisicoria in a dim room, if it dilates it dilates less than the other pupil, mild ptosis and lower lid elevation, lower IOP, DX is confirmed with cocaine test, normal pupil will dilate and normal pupil will not, to distinguish a first and second order from a third order neuron DO use the hydroxyamphetamine test, put it in both eyes, failure to dilate as much makes it a 3rd order neuron DO, CT the chest to evaluate for the possibility of a pancoast tumor
Horner's syndrome
Blood or clot in the anterior chamber, may be black or red, screen for Sickle cell, if they have sickle cell hospitalize, atropine or scopolamine BID-TID, no NSAIDs/ aspirin, monitor for IOP increases, r/o globe rupture, limit physical activity. If PT has sickle cell disease or if it was spontaneous than carbonic anhydrase inhibitors are contraindicated (diamox and truspot), use another dialating agent
Hyphema
baseball player presents to the clinic after being struck in the eye with a baseball. On examination, you note bright red blood in the anterior chamber. What is your initial diagnosis?
Hyphema
(eyelids unable to close) DDX: severe proptosis, or 7th CN palsy/ Bell 's palsy (7th is the hook that shuts the eyes)
Lagopthalmos
retina or optic nerve pathology, observed during the swinging-flashlight test[1] whereupon the patient's pupils constrict less (therefore appearing to dilate) when a bright light is swung from the unaffected eye to the affected eye. The affected eye still senses the light and produces pupillary sphincter constriction to some degree, albeit reduced. The most common cause is a lesion of the optic nerve (between the retina and the optic chiasm) or severe retinal disease.
Marcus Gunn pupil
Emergent Ct, start amphotericin B in D5W, biopsy the necrotic tissue and consult for early surgical debridement of necrotic tissue, fungal invasion into the blood vessels which results in the formation of blood clots and surrounding tissue death by loss of blood supply.[8] If the disease involves the brain, then symptoms may include a one-sided headache behind the eyes, facial pain, fevers, nasal congestion that progresses to black discharge, and acute sinusitis along with swelling of the eye.[9] Affected skin may appear relatively normal during the earliest stages of infection. This skin quickly becomes reddened and may be swollen before eventually turning black due to tissue death, almost always with hyperglycemia and metabolic acidosis.[11] In most cases the patient is immunocompromised
Mucorymycosis
A 44-year-old man presents for follow-up of poorly controlled type I diabetes mellitus, which was diagnosed 32 years ago. What change on his funduscopic examination would indicate a need for urgent referral to an ophthalmologist??t??
Neovascularization
Positive FTA-ABS in the serum or positive CSF VDRL, TX is PenG 2-4 million units IV every 4 hours for 10-14 days followed by bezathine penicillin 2.4 million units (1.2 in each buttock) IM weekly for 3 weeks, repeat LP every 6 months for 2 years and repeat VDRL titer
Neurosyphilis
A 64-year-old African-American man presents after he went blind in his right eye "out of the blue" 20 minutes ago. There is no pain associated with his symptoms and he is not nauseated. Past medical history is positive for DMII for the past ten years. The pupil reaction on the left side is normal with pressure of 17mmHg. Right pupil evaluation reveals no reaction to light or accommodation with pressure of 20mmHg. Right eye ophthalmoscopy reveals arteriolar narrowing, vascular stasis, and "boxcar" pattern. What is the most likely diagnosis?
Occlusion of the central retinal artery
A 14-year-old adolescent is seen in the office for a sports physical for the freshman basketball team. Past history is significant only for a high degree of myopia bilaterally, first diagnosed at age 4 years, and a dislocated shoulder at age 10 years that was easily reduced. Grades are A's and B's. Family history is significant for several unidentified ancestors having died in their forties of an unidentified cardiovascular disorder. Physical examination revealed normal vital signs. Height is 6'1" and weight 145 lbs. The upper to lower segment ratio was 0.65 (decreased). Arm span was 76". The palate was highly arched. Mild pectus excavatum was present. A 2/6 early diastolic murmur was present and was best heard at the second intercostals space at the right sternal border. Arachnodactyly of the fingers and toes and generalized loose jointedness and pes planus were also present. Echocardiography revealed a tricuspid aortic valve with grade 1 out of 4 aortic regurgitation with a normal aortic root diameter. What other evaluation do they need?
Ophthalmology evaluation (Ectopia lentis, retinal detachment, and other ocular anomalies are frequent in Marfan syndrome.)
pain with attempted eye movement with eyelid edema, proptosis, erythema, warmth and tenderness. CT scan shows adjacent sinusitis. Caused by adjacent infection, or direct trauma or infection from blood. Ask for hx of recent illness, tooth pain, neck stiffness, check mental status, CT scan of the orbits and paranasal sinuses, CBC w/ diff, admit and give brood spectrum IV ABX for 48-72 hours, ampicillin-sulbactum or pipercillin-tazobactum or ceftriaxone if allergic to PCN. When it is clearly improving the PT can be discharged of augmentin (amoxicillin/ clavulanate), when caused by S pneumonia can be reduced by use of the pneumococcal vaccine
Orbital cellulitis
MC cause is toxoplasmosis, gradual loss of vision in a quiet eye, cells in the vitreous, needs systemic corticosteroids, VS anterior uveitis responds to topical steroids
Posterior uveitis
usually bilateral, blacks, heredity, visual field and ocular pressure changes, disk cupping, targeted screening at first degree relative, black, diabetes, old, long term steroid TX
Primary open-angle glaucoma
eyes, old, obese, women, around 40 Y/O, s/s of ICP, HA, transient episodes of visual loss precipitated by changes in posture, double vision, pulsatile tinnitus, N/V, findings are papilledema due to ICP, negative MRI of the brain, increased opening pressure on LP with normal CSF composition, may have 6th nerve palsy, RF are obesity, significant weight gain, pregnancy, oral contraceptives, tetracycline's and steroid withdrawal, most important test for following these PTs is visual field testing, TX is weight loss, acetazolamide, discontinuation of causative medications, if intractable HA then neuro shunt, risk during pregnancy is equal for risk of amount of weight gained
Pseudotumor Cerebri
26-year-old man presents with an eye issue. He does not wear corrective lenses. The only change of lifestyle that he states is that, a few months ago, he quit his office job and began to "help out a buddy" in the construction business. On physical examination, there is a triangular fold of tissue extending from the medial conjunctiva to the cornea in both eyes.
Pterygium
drooping of the upper eyelid, visual loss often worse with reading or at night, MC it is benign, other DDX are horners syndrome, CN3 palsy, myasthenia gravis (improvement after application of ice is highly suggestive of myasthenia gravis, chest CT if suspected to r/o thymoma), if PT improves 5-7 minutes after the neosynephrine test they are a good candidate for internal ______ correction, if dry eyes if found work up for autoimmune/ sjorgens
Ptosis
autoimmune disease activated by an infection, commonly a GI infection or a GI infection, causes inflammatory arthritis of large joints, anterior uveitis or chronic conjunctivitic And cervictitis/ urethritis (can't see/ can't pee/ can't climb trees)
Reiter's syndrome-/ reactive arthritis
68-year-old woman presents with episodic, monocular blindness lasting typically less than 5 minutes described as a curtain moving vertically over her visual field. She denies pain or other related vision symptoms. Fundoscopic exam reveals no significant abnormality. What is the most likely cause of the condition described?
Retinal artery emboli
A 68-year-old woman presents with episodic, monocular blindness lasting typically less than 5 minutes described as a curtain moving vertically over her visual field. She denies pain or other related vision symptoms. Fundoscopic exam reveals no significant abnormality. What is the most likely cause of the condition described??
Retinal artery emboli
rapid loss of vision in one eye, curtain spreading across one eye, no pain or redness, detachment seen by ophthalmoscopy, usually due to development of one or more peripheral retinal tears/ holes secondary to spontaneous degeneration in the vitreous, usually in people over 50, nearsightedness and cataracts are the 2 most common RF's, tractional retinopathy can occur due to periretinal fibrosis due to proliferative diabetic retinopathy, about 90% of uncomplicated ______________can be cured with surgery
Retinal detachment
62-year-old woman presents to the Emergency Department with acute unilateral loss of vision for 1 hour. Fundoscopic examination demonstrates vein dilation, intraretinal hemorrhages, and cotton-wool spots with optic disc swelling. Which of the following is the most likely diagnosis?
Retinal vein occlusion
25-year-old man came to the outpatient clinic complaining of redness, itching, and swelling in the right upper eyelid that started 1 day ago. The redness increased, and there has been no eye discharge or watering. On examination, a pustular swelling at the root of the lashes was found. It is surrounded by redness, and it is tender on palpation. The lesion is shown in the following picture. What is the TX?
Warm compresses and local antibiotic cream
Case Cross Highlights A 1.5-year-old boy presents with a squint in the left eye. His mother informed you that the child's eyes were quite normal until about 2 months ago, when she noticed asymmetric movements of her son's eyes. She also felt that the child could not see properly with his left eye. There is no history of trauma to the eye. Child was born at full term and his growth and development were within normal limits. Eye examination showed both eyeballs were equal in size. There was loss of vision in the left eye and a convergent squint in the same eye. Fundus examination showed absence of red reflex in the left eye, and instead a white pupillary reflex (leukocoria) was seen. X-ray of the skull showed calcification within the globe.
Retinoblastoma
most commonly caused by toxoplasmosis, most cases are congenital, most common symptom is decreased visual acuity in one eye. The diagnosis is made by examination of the eye, using ophthalmoscopy. Sometimes serologic testing is used to rule out the disease, but due to high rates of false positives, serologies are not diagnostic of toxoplasmic retinitis. If vision is not compromised, treatment may not be necessary. When vision is affected or threatened, treatment consists of pyrimethamine, sulfadiazine, and folinic acid for 4-6 weeks. Prednisone is sometimes used to decrease inflammation
Retinochoroiditis
(rare) a sarcoma (cancer of connective tissues), in which the cancer cells are thought to arise from skeletal muscle progenitors. It can also be found attached to muscle tissue, wrapped around intestines, or in any anatomic location. It mostly occurs in areas naturally lacking in skeletal muscle, such as the head, neck, and genitourinary tract. Most commonly seen in children aged one to five years old. DX by biopsy, imaging of choice is MRI
Rhabdomyosarcoma
Scleritis VS Episcleritis (what are the key differences)
Scleritis does NOT blanch when phenylephrine is applied VS Episcleritis will blanch, Scleritis has severe boring eye PN and is usually in old people VS Episcleritis has less PN and is usually in young adults: MC Cause is idiopathic, TX is NSAIDS and artificial tears
white precipitate that is not steamed, usually immunologic, pain, redness, photophobia, and visual loss, inflammatory cells and flare in the aqueous, kertic precipitates (larger in granulomatous uveitis, smaller in agranulomatous), responds to topical corticosteroids VS posterior needs systemic, atropine/ cyclopegics to relieve pain by immobilizing the iris, To prevent adhesion of the iris to the anterior lens capsule (posterior synechia), which can lead to iris bombe and elevated IOP, To stabilize the blood-aqueous barrier and help prevent further protein leakage (flare)
Severe anterior uveitis- The same as Iritis
binocular horizontal diplopia worse with distance vision, deficient lateral movement
Sixth nerve palsy
consider use of blood thinners or blood dyscarias/ coagulopathies, evaluate by gonioscopy PT and INR, CBC, bleeding time, protein C and S, cyclopege with atropine
Spontaneous hyphema
18-year-old man presents with blurred vision and some eye pain that began 2 days ago and has become progressively worse. Upon examination, the eye is slightly edematous with a white to yellow exudate present under the eyelid and at the corner. The rest of his clinical and physical history is unremarkable. A conjunctival scraping is obtained and gram stained. Based on the gram stain result, the conjunctival scraping was sent to the laboratory for culture and sensitivity. The patient is given instructions for topical antibiotic ointment treatment (polymixin B/trimethoprim) to be administered every 2-4 hours for 7-10 days. Pathology later shows that the conjunctival scraping culture grew out a beta hemolytic organism that was catalase positive, coagulase positive, and gram stained as gram-positive cocci. What is the most likely causative organism of the patient's conjunctivitis?
Staphylococcus aureus
35-year-old man presents with a piece of wood sticking out of his right eye. He denies any past medical or surgical history or any alcohol ingestion; however, he smells of alcohol. He states that his tetanus immunization is up-to-date. What is most appropriate in the management for this patient?
Start the patient on intravenous antibiotics (Ophthalmic ointments should be avoided, as they may penetrate the globe. Also, one should never give oral antibiotics, as the patient may need surgery to remove the foreign body.)
unequal light reflex
Strabismus
disruption of conjunctival blood vessels from trauma, sneezing, gagging, Valsalva that will spontaneously resolve within 2 weeks, when dense bloody chemosis is present globe rupture must be ruled out. No TX necessary
Subconjunctival hemorrhage
A 36-year-old woman presents with a small and irregular right pupil. On exam, you note that the pupil does not respond to direct or consensual light stimuli; however, it becomes smaller during an accommodation testing. What is the most likely diagnosis??
Tertiary syphilis (pupil describe here is the Argyll Robertson pupil. The pupil reacts poorly to light, but it reacts well to accommodation.)
A 25-year-old man came to the outpatient clinic complaining of redness, itching, and swelling in the right upper eyelid that started 1 day ago. The redness increased, and there has been no eye discharge or watering. On examination, a pustular swelling at the root of the lashes was found. It is surrounded by redness, and it is tender on palpation. The lesion is shown in the following picture.
external hordeolum/ stye
6-year-old girl presents with a 2-day history of a small, tender, superficial abscess on her left upper eyelid at the lid margin. She denies discharge, fever, or trauma. There is mild pain on palpation, and she has a normal ophthalmic exam. What treatment should be given?
Warm compresses
blurred vision and floaters, redness and photophobia, pain is absent, new unilateral white yellow retinal lesion associated with old chrioretinal scar, vitreous reaction directly over the lesion, does the PT eat raw meat or have exposure to cats, draw anti-_____________ titer, TX is pyrimethane and folinic acid, TX during pregnancy is spiramycin
Toxoplasmosis
R/O FB, if caused by bacillus PT will have high fever, leukocytosis, proptosis, and a corneal abcess in the form of a ring with rapid visual deterioration, TX w/ fortified topical ABX tobramycin/ cefazolin/ vacomycin
Traumatic endopthalmitis
UV burns of the cornea caused by use of sunlamp without protection, exposure to welding, or exposure to the sun when skiing. No immediate symptoms, 6-12 hours later the PT CO agonizing PN and severe photophobia, slit lamp and staining shows diffuse punctate staining of both corneas, TX is binocular patching and cyclopentalate, recovery within 24-48 hours, local anesthetics are contraindicated because they delay corneal epithelial healing
Ultraviolet keratitis
Bilateral itching thick ropey discharge, usually in boys in spring and summer in younger PTs, large conjunctival papillae/ bumps under the eyelid, treat as allergic, late childhood/ early adulthood,
Vernal keratoconjunctivitis- Atopic Conjunctivitis
63-year-old woman presents to her ophthalmologist with a complaint of decreased vision in the right eye. On examination, her right lens is noted to have a mild opacification, and she is diagnosed as having a cataract. Which of the following complaints might she also have?
Visual halos around objects
sudden vision loss, abrupt onset of floaters that progressively increase in severity, VA ranges, eye is not inflamed, a clue is inability to see fundus clearly despite clear lens or localized blood in front of the retina, MC cause is diabetic retinopathy
Vitreous hemorrhage
A 28-year-old man came to the ER complaining of diplopia and the inability to move the right eye outwards. He was hit by a ball on the right side of his face while playing volleyball 2 hours ago. His symptoms are non-progressive. On examination, his visual acuity was normal in both eyes. Right eye was medially deviated and could not be moved laterally; otherwise, there was no abnormality detected. What is the name and number of the CN affected?
abducens
previously healthy 5-year-old boy presents with complaints of bilateral eye pain and redness. The child's mother reports that several children in his daycare facility have had similar symptoms. Results of physical exam indicate bilateral nonsuppurative conjunctival inflammation, photophobia, and preauricular lymphadenopathy. What is the most likely organism responsible for this outbreak of conjunctivitis??s??
adenovirus
A 52-year-old man presents with a burning sensation of both eyes. He denies recent trauma and ill contacts. On examination, his eyelid margins are red and inflamed. His eyelashes are greasy and adherent with a surrounding dandruff-like scale. Conjunctiva are clear.
blephritis
acute or chronic granulomatous infection of the meibomian gland, TX with warm compress and Erythromycin ointment and 14-21 days Doxy for refractory cases/ refer to optometry
chalazion
A client comes into the clinic with a complaint of a hard, non-tender swelling on the upper lid of her left eye. The conjunctiva in the region of the lesion is red and elevated. What is the most likely diagnosis?
chalzion
Which test can detect esotropia
corneal light reflex test
cholesterol embolus that is seen in a blood vessel of the retina, seen when a physician performs ophthalmoscopy, during which a plaque will appear bright, refractile, and yellow. It is caused by an embolus lodged within the retinal vessel that originated from an atheromatous plaque in a more proximal (upstream) vessel, usually the internal carotid artery. It is often an indication of a previous ischemic episode in the eye and is a sign of severe atherosclerosis. The most important step in management is to identify and treat the originating plaque to prevent further embolization.
hollenhorst plaques
Dilated central and conjunctival vessels, dilated pupil, and decreased vision
red eye caused by glaucoma
A 2 week old female infant is seen for her newborn well baby exam after a normal birth and delivery. She has been nursing well, has regained her birthweight and her development appears normal for her age so far. Physical examination is normal with the exception that ophthalmoscopic evaluation reveals a faint white reflex in her right eye. What is the most likely diagnosis?
retinoblastoma
