CLIN MED - EYE DISEASES

Terms	Definitions
papilledema	What is the likely diagnosis?
chalazion	What is the likely diagnosis?
seborrheic marginal blepharitis	What is the likely diagnosis?
hordeolum	What is the likely diagnosis?
dacrocystitis	What is the likely diagnosis?
dacroadenitis	What is the likely diagnosis?
neovascular glaucoma	Which type of glaucoma is the method of blindness in Diabetes Mellitus?
True	True or False: Neovascular Glaucoma is initially a quiet presentation that progresses to a red eye with increased intraocular pressure.
topical beta-blockers, miotics, alpha agonists, carbonic anhydrase inhibitors, topical atropine, steroids, and retinal laser photocoagulation	What is the treatment for neovascular glaucoma?
1st branch	Which branch of the trigeminal nerve is associated with herpes zoster ophthalmicus?
Elevated IOP with a white eye	Chronic open angle glaucoma is associated with a white or red eye?
White	Chronic angle closure glaucoma is associated with a white or red eye?
white	Steroid-induced glaucoma is associated with a white or red eye?
white	Old trauma or previous inflammation can increase intraocular pressure and is associated with a white or red eye?
red	Acute angle closure glaucoma is associated with a white or red eye?
red	Neovascular glaucoma is associated with a white or red eye?
red	Herpes Zoster and uveitic glaucoma are associated with a white or red eye?
red	Acute ocular or orbital trauma is associated with increased intraocular pressure with a white or red eye?
primary open angle glaucoma	What is the most common form of glaucoma?
blockage of the aqueous outflow in the trabecular meshwork	What causes the increased IOP in primary open angle glaucoma?
cloudy/steamy cornea with edema and injection of the sclera. Pupil is mid-dilated and fixed and can be eccentric	What is the "textbook description" of acute angle closure glaucoma?
acute angle closure glaucoma	In which eye disease is the IOP usually >50?
vessels grow across the trabecular meshwork leading to mechanical closure of the angle	Describe the mechanism in which increased IOP occurs in neovascular glaucoma:
diabetic retinopathy or central retinal vein occlusion	Which two diseases cause ischemia of the retina and formation of new blood vessels?
True	True or False: The initial sx of neovascular glaucoma are initially quiet but lead to increased IOP with a red eye
Hutchinson's sign	What is the term used to define vesicles often seen on the nose that also indicate the need for an eye exam?
False --> high incidence	True or False: Zoster of the 1st branch of the trigeminal nerve has a low incidence of ocular involvement
True	True or False: IOP elevation in herpes zoster ophthalmicus is often asymptomatic
acyclovir, famciclovir, oral steroids, and anti-glaucoma meds	What are the four meds usually used in herpes zoster ophthalmicus?
beta blockers, alpha agonists, carbonic anhydrase inhibitors	What meds are used to decrease aqueous production in the mgmt of glaucoma?
sympathomimetics and parasympathomimetics	What meds are used to improve aqueous outflow in the mgmt of glaucoma?
hyperosmotic agents	Which meds are used to decrease vitreous volume in the mgmt of glaucoma?
when meds dont work	When should lasers be used for the tx of glaucoma?
when meds and lasers dont work	When should surgery be used for the tx of glaucoma?
molluscum contagiosus	What disease has mutiple dome-shaped, skin-colored, umbilicated nodules from which a cheesy material may be expressed?
pox virus	What causes molluscum contagiosus?
incision and gentle curettage	What is the tx for molluscum contagiosus?
HPV; grows on lids after autoinoculation; excision	What is the cause, location, and tx of Verrucae in regards to viral eye infections?
unilateral crop of vesicles on a swollen, red base that often appears on the lower lid	What is the classic presentation of HSV in regards to viral eye infections?
oral acyclovir and topical vidarabine eye drops	What is the treatment of HSV?
varicella zoster	What disease has a sudden onset of fever and preherpetic neuralgia pain occurs in the nerve distribution?
antidepressants, gabapentin, pregabalin	With what should you treat post-herpetic neuralgia?
external hordeola	What is the term used to define a purulent inflammation of lash follicles and adjacent glands?
internal hordeola	What is the condition characterized by the painful involvement of the meibomian glands?
True	True or False: Both internal and external hordeolum cause pain, reddness and swelling of the lid margin which may abscess
hot compresses and ABX sensitive to Staph. I&D may be needed	What is the tx plan for hordeolums?
False - Rare	True or false: Fungal infections of the eyes are common
crab lice	What is the likely culprit when nits are seen glued to the lashes?
hair follicle mite	What is another term for Demodex follicularum?
sebaceous gland mite	What is another term for Demodex brevis?
chronic blepharitis and meibomianitis	Both hair follicle and sebaceous gland mites can infect the pilosebaceous unit of the eyelid causing what two eye conditions?
marginal blepharitis	What eye disease is associated with a staph infection, seborrhea, acne, rosacea, and dry eyes?
staphylococcus	What is the most causative agent of marginal blepharitis?
burning, itching, red eyes	What sx does a pt complain of with marginal blepharitis?
lid margin scarring with misdirection of eye lashes and corneal injury	What is the end result of marginal blepharitis if left untreated?
trichiasis	What is the medical term for eyelash misdirection?
True	True or False: staph toxins in marginal blepharitis may cause conjunctivitis or corneal erosions / ulcers
staphylococcal marginal blepharitis	What eye disease begins in childhood and may last a lifetime, with dilated skin vessels and yellow crusting at lash roots that bleed and ulcerate if removed?
madarosis	What is the medical term for loss of eyelashes?
poliosis	What is the medical term for decrease or absence of color in the hair or eyelashes?
tylosis	What is the medical term for the thickening of the eyelid?
True	T or F: A recurrent stye may occur in staph. marginal blepharitis
False: staph. marginal bleph bleeds, seborrheic does not	T or F: The greasy crust of seborrheic marginal blepharitis bleeds upon removal
meibomian glands hypersecrete and the excess lipids can lead to conjunctivitis or corneal ulcers	Describe the mechanism behind seborrheic marginal blepharitis and other eye conditions
True	T or F: Tx of blepharitis may be lifelong
for flare-ups after scrubbing	When would topical ABX be appropriate for the tx of blepharitis?
only if severe	Should steroids be used in the tx regimen of blepharitis?
if rosacea is suspected	Why would you add tetracycline to the tx regimen of blepharitis?
chalazion	Duct obstruction causes a lipogranulomatous inflammation of a sebaceous gland known as what?
rosacea and seborrhea	With what two conditions is a chalazion often associated?
No	Is a chalazion painful?
treat underlying blepharitis and add hot compresses QID. I&D prn	What is the tx of a chalazion?
dacroadenitis	In which condition is an "S-shaped" upper lid, ptosis, and preauricular adenopathy seen?
viral or bacterial	What is the cause of dacroadenitis?
fullness or pain in upper outer lid; firm, tender swelling of lateral lid	What are the complaints or sx commonly seen in dacroadenitis?
epiphoria	What is the medical term used to define excessive tearing?
dacrocystitis	A 45 y.o. female pt presents with an irritated eye with excessive tearing and a swollen area medially under the eye. What is the likely dx?
Staph aureus, Step Pneumo, GAS	What three organisms are the likely culprits of dacrocystitis?
thyroid-associated ophthalmopathy, most often grave's disease	What is the most common cause of uni or bilateral proptosis?
autoimmune inflammation of extraocular muscles and periorbital connective tissue	Describe the mechanism behind proptosis in thyroid-associated ophthalmopathy:
sarcoidosis	What disease is associated with uveitis, eyelid nodules, keratoconjunctivitis sicca, chorioretinitis, lacrimal gland enlargement, conjunctival nodules?
prednisone	What med is the preferred tx in sarcoidosis?
Sjogren's syndrome	What disease is a chronic, systemic inflammatory disease associated with dry eyes, mouth and mucous membranes?
Rheumatoid arthritis, systemic lupus erythmatosis, mitz connective tissue disorder, scleroderma, and other autoimmune diseases	What is Sjogren's syndrome commonly associated with?
acute orbital cellulitis	Which eye condition threatens both vision and life?
preseptal acute orbital cellulitis	A pt presents to your office with painful lid swelling, chemosis, fever and leukocytosis. What is the dx?
postseptal acute orbital cellulitis	A pt presents to your office with painful lid swelling, fever, proptosis, restricted EOM, and visual disturbances. What is the dx?
False	True or False: Preseptal and postseptal acute orbital cellulitis have the same tx regimen.
extension of bacterial sinusitis	What is the common cause of acute orbital cellulitis?
Staph Aureus, Streptococcal species, and Haemophilus influenza (particularly in peds)	What are the three common bacterial culprits of acute orbital cellulitis?
vessels at the disc margin are still defined and drusen are present	What two things will you see in pseudopapilledema that do not occur in papilledema?
fluorescien angiography will result in leakage of dye into and around the disc in true papilledema	How can you differentiate true papilledema from pseudopapilledema?
oral ABX and compresses	What is the tx for preseptal acute orbital cellulitis?
IV ABX and hospitalize with consultation	What is the tx for postseptal acute orbital cellulitis?
May progress to cavernous sinus thrombosis	Why is postseptal acute orbital cellulitis so dangerous and requires immediate treatment?
papilledema is associated with increased ICP whereas pseudo is not	What is the difference in intercranial pressure between true and pseudopapilledema?
ocular hypotony from surgery, seen most frequently after cataract surgery	What is the cause of unilateral optic disc swelling?
papillitis	What is the most common cause of visual loss associated with disc swelling under 40 years of age?
anterior ischemic optic neuropathy	What is the most common cause of visual loss associated with disc swelling over 50 years of age?
sensory visual system	Vision loss is associated with which system?
ocular motor system	Double vision, blurred vision, or difficulty fixating on an object is associated with which system?
neuroretinitis	If papillitis is accompanied by exudates, what does it then become?
False	T or F: Retrobulbar optic neuritis usually presents with disc swelling?
1. swollen 2. pale, usually d/t atrophy 3. morphological or structural abnormality	What are the three ways in which the optic nerve head may appear abnormal:
optic chiasm	Tunnel vision usually occurs with a problem in which part of the brain?
1. Physiologic anisocoria (20% of population has this) 2. Horner's syndrome	What two things should be considered if unequal pupils are noted but both react to light?
Argyll-Robertson pupils	Which eye disorder has pupils that accommodate but do not react to light?
neurosyphilis, midbrain lesions, DM, or ETOH	What underlying diseases are commonly seen in Argyll-Robertson pupils?
ocular hypotony	Which condition has a normal ICP with a low IOP?
bilateral visual field defects (classically a temporal hemianopsia)	What type of visual defect results with chiasmal involvement?
optic disc	A problem in which area of the eye results in sectoral or arcuate visual defects?
central vision loss	Retrobulbar optic nerve disease produces vision loss in what visual field?
retrochiasmal defects	Complete or partial homonymous hemianopsia which is always bilateral occurs in a defect of which part of the optic tract?
9-21	What is the normal pressure of CSF?
True	T or F: Vision is usually preserved in papilledema
headache	What is the usual symptom or complaint with papilledema?
CT scan or MRI	What follow-up test must be performed once the dx of papilledema has been made?
mass lesion, trauma with edema or bleeding, infection, severe HTN, acute ETOH intoxication, pseudotumor cerebri	What are the 6 etiologies for papilledema outlined in the slides?
benign intracranial hypertension	What is another term for pseudotumor cerebri?
chronic progressive external ophthalmoplegia (CPEO)	What condition involving the ocular motor system is associated with heart block and sudden cardiac death?
bilateral ptosis	What is an early sign of CPEO?
females of childbearing age (20-40 y.o) who are obese	Who is most at risk for benign intracranial HTN?
CSF pressure is elevated as confirmed by lumbar puncture; tx with lifelong LPs or surgical ventricular peritoneal shunting.	What is the abnormality noted in benign intracranial hypertension and what is the proper treatment modality?
False: the vessels remain sharply defined	T or F: Similar to papilledema, pseudopapilledema is marked by obscured small vessels at the disc margin
macular degeneration and pseudopapilledema	Which two eye diseases are marked with drusen?
True	T or F: Pseudopapilledema is not associated with increased ICP.
false --> bilateral	T or F: papilledema is normally a unilateral problem
cataract surgery	Following (__________) is the most common cause of ocular hypotony, or unilateral optic disc swelling.
cranial nerve 4 palsy	What condition would cause vertical or oblique diplopia that worsens with downward gaze
CN 6 palsy	Which condition has an associated horizontal diplopia that worsens when looking toward the affected side?
papilledema, pseudopapilledema, benign intracranial HTN, ocular hypotony	Which four conditions have optic disc swelling but preserve vision?
True	T or F: CN 6 palsy may cause CN 4 palsy
trauma	What is the most common cause of CN 4 palsy?
anterior	In papillitis, inflammation of the optic nerve occurs in the anterior or posterior portion?
False - no disc swelling	T or F: Retrobulbar optic neuritis usually presents with disc swelling?
AION	Which is more common: papillitis or AION?
microvascular infarction with palsy that spares the pupil	What is a common cause of CN 3 palsy?
True	T or F: Bilateral involvement in anterior ischemic optic neuropathy is rare
Anterior Ischemic Optic Neuropathy	A pt presents with sudden, painless central altitudinal vision loss in the right eye. What is the dx?
multiple sclerosis	Acute bilateral internuclear ophthalmoplegia is highly suggestive of what condition?
AION	Upon exam, you see a swollen, pale optic disc with areas of hyperemia. What is the dx?
CBC, ESR, FBS, ANA, RPR, PT/PTT	What six lab tests would you order if a pt presents with painless central vision loss and denies recent cataract surgery?
AION	A variety of vasculitides, coagulopathies, and systemic diseases may contribute to the development of which condition?
Idiopathic AION; tx with ASA 1 tab/day	A 45 year old male with hx of HTN and DM presents to your office with sudden painless visual loss in one eye. You educate the pt that this condition leads to permanent visual defects. What is the dx and tx?
rapid bilateral blindness	AION with temporal arteritis is a treatable medical emergency. What will occur if left untreated?
ESR	What is the first lab test you do in a pt >50 yo who presents with sudden vision loss and a swollen optic nerve?
prednisone 1mg/kg/d	What is the immediate treatment if temporal arteritis is suspected?
papillophlebitis	What dx is similar to retinal vein occlusion, but has slow moving, sludgy blood?
glaucoma	Papillophlebitis may develop secondary to which eye condition?
CN 6 palsy	What is the dx?
neoplasms	What can cause optic disc swelling from external compression of optic nerve leading to venous congestion or by infiltrating the nerve?
gradual	Will external compression of the optic nerve lead to gradual or rapid vision loss?
rapid	Will neoplasmic infiltration of the optic nerve lead to gradual or rapid vision loss?
hypothyroidism	Enlarged extraocular muscles may cause compression on the optic nerve secondary to what underlying condition?
Leber's hereditary optic neuropathy; educate that there is no treatment and there will be permanent central vision loss	A 5yo pt presents with painless vision loss. Upon exam, the optic disc appears hyperemic with engorgement of peripapillary capillaries. Pt also has cardiac problems. What is the dx and education needed?
Retrobulbar optic neuritis	A 25yo woman presents with blurred vision that "came and went". The pain is worse upon movement of the affected eye. The fundus appears normal. What is the dx?
True	T or F: Improvement occurs within one month with or without treatment in retrobulbar optic neuritis
multiple demyelinated areas of white matter	What would an MRI reveal in a pt with retrobulbar optic neuritis?
Multiple Sclerosis	What condition is highly associated with retrobulbar optic neuritis?
IV methyprednisolone	What tx would be provided to a pt with retrobulbar optic neuritis?
No - only IV	Are oral steroids beneficial in the mgmt of retrobulbar optic neuritis?
gliomas	What condition is found predominantly in children, associated with neurofibromatosis and proptosis, visual loss, disc swelling, and optic atrophy is also present?
amaurosis fugax	What is the term describing a vascular occlusion that may cause loss of vision for a few seconds up to half an hour?
carotid artery amaurosis; evaluate with carotid doppler or angiography; tx = anticoagulants, antiplatelet agents, or endarterectomy	A pt comes in with tingling and pain in the right arm and complains of dimming vision of the left eye. What dx is likely, how would u evaluate, and what is proper tx?
flash of light with loss of vision	What is a scintillating scotoma?
saccades	Rapid eye movements that fix fovea when moving from 1 item to the next
fixation	allows fovea to remain on object once captured
smooth pursuit	slow movements to keep object in focus while it moves
vestibulo-ocular mechanisms	moves eyes in concert with semicircular canals to allow fixation while head or body moves
vergence mechanism	produces disconjugate movement to adjust eyes to maintain fixation
False --> always disappears	T or F: Binocular diplopia does not disappear with one eye covered
lateral rectus	Which muscle is affected if there is esodeviation of the eye with diplopia that worsens at a distance?
medial rectus muscle	Which muscle is affected if there is exodeviation with worsening diplopia at a near distance?
True	T or F: Diplopia is usually a benign, self-limiting process
affect one eye, cranial nerves, extraocular muscles, and cause diplopia	What is affected in infranuclear disorders, or diseases below the brain?
cortex, movement of both eyes	What is affected in supranuclear (central) disorders?
Tx with pyridostigmine, corticosteroids, or azathioprine. Thymectomy if thymus enlarged	What is the tx of myasthenia gravis?