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opthalmology
optho review for med surg final
66
Other
Graduate
12/11/2009

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Term
cloudy vision, eye ache and/or headache, increased IOP, nausea and vomiting
Definition
acute angle closure glaucoma
(do an orbital CT on these pts)
Term
most common cause of acute angle glaucoma
Definition
pupillary block, hyperopia, meds (sulfa derived), tumors
Term
cornea becomes edematous, less transparent, hazy cornea, complains of foggy vision, halos. on PE- hazy cornea, mid-dilated, non-reactive pupil. IOP as high as 50mm. swelling of optic disc.
Definition
Acute angle glaucoma
Term
normal IOP
Definition
10-20mmHg
Term
treatment for acute angle glaucoma
Definition
-topical alpha-agonist
-topical beta blockers
-carbonic anhydrase inhibitors
-prostaglandin analogs
-miotic agents
-recheck IOP hourly, initially
-optho consult IMMEDIATELY
Term
most common cause of acute reduction in vision because of optic nerve dysfunction in 20-40 year olds.
-women> men.
- painful rapid vision loss, especially with eye movement
-color vision changes
Definition
optic neuritis
Term
treatment for optic neuritis
Definition
-none to IV steroids, not PO
-MRI of the brain
-optho stat
-neuro stat
-methylprednisolone 250mg IV QIDx3 days, then oral
Term
-sudden, profound, PAINLESS, monocular vision loss
-retina is pale, edematous, transparent
-"CHERRY RED SPOT"
Definition
CRAO
Term
What are some causes of CRAO?
Definition
-embolus
-giant cell arteritis
-vasculitis
-sickle cell
-trauma
Term
as far as damage to the eye...
Definition
-retina= irreversible damage in 90 min
of a total occluded vessel
-IOP lower drugs
-breathing into paper bag
-Stat Optho
Term
painless, loss of vision, monocular, rapid. causes venous stasis, edema, hemorrhage. shows optic disc edema, retinal hemorrhages. "COTTON WOOL SPOTS" 90% pts over 50yo
Definition
CRVO
Term
sudden, unilateral painless, visual field defect, may have normal vision. shows tortuous retinal veins, COTTON WOOL SPOTS. macular edema, vitreous hemorrhage
Definition
BRVO
Term
caused by EMBOLI, usually in the elderly, HTN, carotid disease, DM, cardiac valve disease
-sudden, unilateral, painless, partial loss of vision
Definition
BRAO
Term
sx- HA, fever, malaise, scalp tenderness, weight loss, jaw claudication, amaurosis fugax, diplopia, eye pain
->55yo
-other eye involved in 75% of cases within 2 weeks without tx
Definition
giant cell (temporal) arteritis
Term
pt will have swollen, tender, temporal artery, cotton wool spots, CN palsy
Definition
GCA
Term
-acute onset of photopsias, floaters, shade or cob web, shadow or curtain across the visual field, decreased vision, may be asymptomatic. IOP IS LOWERED IN THE AFFECTED EYE.
Definition
retinal detachment
Term
temporary loss of vision in one eye/both eyes due to a block of blood flow to the retina. shade or curtain coming down.
Definition
amaurosis fugax
Term
AKA infectious keratitis
-contact lenses, trauma, dry eyes, lid abnormalities can cause this. pseudomonas, staph can cause this.
Definition
corneal ulcer
Term
warm, erythematous, tender lids, periorbital swelling. low grade fever, elevated WBS, decreased vision and sluggish pupillary response, proptosis, restricted ocular motility
Definition
orbital cellulitis
Term
tx for orbital cellulitis...
Definition
IV antibiotics and surgical drainage
Term
SEVERE pain and foreign body sensation, photophobia, conjunctival injection, involuntary lid closure, decreased visual acuity, hx of mild trauma to eye
-CONJUNCTIVAL HYPEREMIA, swollen eyelids, excess tearing, NO DISCHARGE, immediate relief with topical anesthesia
Definition
corneal abrasions
Term
tx for corneal abrasion...
Definition
-slit lamp exam
-evert the eyelid
-topical antibiotic
Term
hx of welding or sunbathing. red eyes, tearing, blurred vision, photophobia, symptoms occur 6-12 hours after activity.
Definition
ultraviolet keratitis
Term
hx of welding or sunbathing. red eyes, tearing, blurred vision, photophobia, symptoms occur 6-12 hours after activity.
Definition
ultraviolet keratitis
Term
hx of welding or sunbathing. red eyes, tearing, blurred vision, photophobia, symptoms occur 6-12 hours after activity.
Definition
ultraviolet keratitis
Term
-blood collection in the anterior chamber
-hx of blunt trauma
-pain, blurred vision, and red eye
Definition
hyphema
Term
-extraocular movements are restricted.
-numbness or tenderness of upper cheek/lip
-enophthalmos
Definition
blow-out fracture
Term
dendritic "tree branching" with stain
Definition
herpes simplex keratitis
Term
forehead rash, eyelid edema, conjunctival etc., hyperemia, uveitis, glaucoma. tx is acyclovir
Definition
herpes zoster ophthalmicus
AKA varicella zoster ophthalmicus
Term
recurring inflammation of the episcleral tissue, hyperemia of the globe. tx is usually self-limited, prednisone topical, oral NSAIDS
Definition
episcleritis
Term
severe, destructive, vision threatening condition. underlying connective tissue disorder. meds is corticosteroids.
Definition
scleritis
Term
positive seidel's sign (bright stream of fluorescein as aqueous leaks from the wound)irregular pupil due to iris. associated with inflammation
Definition
corneal laceration/perforation
Term
pressure patch?
Definition
DO NOT PRESSURE PATCH A LACERATED OR PERFORATED EYE
Term
common, benign orbital tumor. appears as strawberry nevus if located in more external orbit or as a blue eyelid mass if deeper in orbit. occurs in first year of life and slowly involutes by age 5. eyelid may cause ptosis
Definition
capillary hemangioma
Term
-common, benign lesion
-painless, palpable, flesh colored mass
-composed of connective tissue
-presents in early childhood and may slowly enlarge
Definition
dermoid
Term
most common PRIMARY pediatric orbital malignancy. usually occurs in pts <15 yo. VERY RAPID ONSET of unilateral proptosis.
Definition
rhabdomyosarcoma
Term
most common INTRAOCULAR malignancy in children. most diagnosed by age 5. most unilateral, hereditary. good prognosis but this is HIGHLY MALIGNANT AND METASTATIC. sx- stabismus, decreased vision, swelling, asymptomatic, parents may notic an unusual reflex in photos. may have LEUKOCORIA(white reflex)
Definition
retinoblastoma
Term
management for retinoblastoma?
Definition
Head and orbital MRI to look for extension, enucleation for large tumors
Term
most common primary intraocular tumor in adults. most lethal primary skin tumor-rare on eyelids. metastasis is most commonly to the liver. almost always unilateral. mostly asymptomatic
Definition
melanoma
Term
flat or slightly elevated scaly, ulcerated, erythematous plaque, more common in older pts with lighter complexion, potentially metastatic and locally invasive. management is excisional biopsy with wide surgical margins.
Definition
squamous cell carcinoma
Term
firm nodule with ulcerate center and rolled "pearly" borders. 90% of all eyelid malignancies. occurs in older pts. slow growing, does not metastasize but locally invasive.
Definition
basal cell carcinoma
Term
progressive visual loss from months to years. glare. monocular diplopia. fixed spots in visual field. decreased color perception.
Definition
cataract
Term
in the western world, the leading cause of blindness.loss of vision= injury to retinal vasculature.
Definition
diabetes
Term
results from ischemia. neovascularization. may have 20/20 vision.vision may decrease slowly. floaters, blind spots. COTTON WOOLD SPOTS, fine, lacy blood vessels seen, loss of red reflex.
Definition
proliferative diabetic retinopathy
Term
earliest detectable clinical alteration, formation of microaneurysms. "dot and blot hemorrhages", exudates
Definition
diabetic macular edema
Term
hallmark is diffuse arteriolar narrowing with blood vessel walls being virtually invisible."COPPER-WIRE VESSEL" A:V nicking. cotton wool spots, microaneurysms, retinal edema.
Definition
hypertensive retinopathy
Term
vision loss secondary to vasculitic occlusion that involes the arteries to the optic disc. ESR IS GREATER THAN 50.
Definition
giant cell arteritis
(tx is high dose steroids)
Term
autoimmune disorder--> neuromuscular junction. variable weakness of voluntary muscles. improves with rest and worsens with activity.multiple muscle weakness.
Definition
myasthenia gravis
Term
with graves disease (hyperthyroidsm)
Definition
exopthalmos
Term
most common severe infection affecting the eye in HIV/AIDS pts that usually occurs in the late stages of disease.
Definition
CMV retinitis
Term
systemic, multisystem collagen vascular disease. inflammatory joint pain. damages salivary and lacrimal glands.can present as necrotizing scleritis, painful, foreign body sensation, scleral thinning.
Definition
rheumatoid arthritis
Term
intracranial mass, impedment of cerebrospinal flow, idiopathic intracranial hypertension can cause this condition...
sx- HA, nausea with vomiting, transient episodes of vision loss in BOTH EYES
Definition
papilledema
Term
Unilateral swollen optic disc (papillitis), FLAME SHAPED hemorrhages, optic disc pallor, sudden painless vision loss
Definition
ischemic optic neuropathy
Term
-ptosis, diplopia, HA or periorbital pain, eye is turned down and out, dilated pupil
Definition
third nerve palsy
Term
-pts may develop a head tilt
-vertical/oblique diplopia occurs
-trochlear nerve
-common from trauma
Definition
fourth nerve palsy
Term
involuntary movement of the eyes. composed of a mixture of slow and fast movements of the eyes
Definition
nystagmus
Term
most common type of nystagmus associated with alcohol intoxication and cerebellar or brainstem disease
Definition
acquired nystagmus
Term
associated with neurosyphilis, pupil is small and responds slowly to light, accomodation and convergence is retained. etiology unclear.
Definition
argyll robertson syndrome
Term
dilater pupil that reacts poorly to light, but better to accomodation. reaction is SLUGGISH and TONIC. Usually unilateral.
Definition
Adie's tonic pupil
Term
injury to the sympathetic nerves of the face characterized by PTOSIS, PUPILLARY MIOSIS, FACIEAL ANHIDROSIS.
Definition
horner's syndrome
Term
in this condition the pupil of the affected eye paradoxically dilates when light is shone in the eye. The brain is not receiving the message properly.
Definition
marcus gunn pupil
Term
this is the most common type of eye turn occurring in 1-2% of the population
Definition
esotropia
Term
reduced vision that is not correctable with lenses. usually only in 1 eye. AKA LAZY EYE. this develops when an eye has not received adequate use during early childhood.
Definition
amblyopia
Term
in children, this is a sign of poor vision until proven otherwise...
Definition
nystagmus
Term
AKA EXUDATIVE RETINITIS. a progressive condition of the retinal capillaries which occurs in children and young adults, usually males. First decade of life, it is gradual in progress and affect central vision usually in one eye.
Definition
coat's disease
Term
AKA EXUDATIVE RETINITIS. a progressive condition of the retinal capillaries which occurs in children and young adults, usually males. First decade of life, it is gradual in progress and affect central vision usually in one eye.
Definition
coat's disease
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