Ophthalmologic Exam Part 2
Cataract: is the opacity of the crystalline lens
2- True! Leading cause of blindness worldwide (not in the US though)
4- Surgery is the treatment!
-Congenital is hard to treat because the of changes in the optics of the eye with growing influencing choice of intraocular lens power, and the treatment of associated amblyopia
Your PTis complaining of blurry vision and a glare of bright light, especially bright light or when driving at night.
1- What is the condition?
2- T/F This condition is the leading cause of blindness worldwide (not in the US though)
3- What habits increase the risk of this condition?
4- What is the treatment? Why is the treatment difficult in the congenital form of the disease?
| 1- Congenital Causes: Intrauterine infections such as rubella, CMV, galactosemia|
2- Diabetes, myotonic dystrophy, atopic dermatitis
3- Trauma, systemic or inhaled corticosteriods treatment, or uveitis
4- Senile (disease of old age)!
| 1- List the congenital causes of cataracts (3)|
2- List the systemic diseases with which cataracts are associated (3)
3- List three other possible causes of cataracts.
4- What is the most common cause?
| 1- Dislocation of the Lens:|
- Dislodgment of lens from ciliary body attachments due to the weakening of zonules (Eg. Suspensory ligaments)
• Blunt trauma
• Hereditary (connective tissue disorder)
3- Lens extraction (IOL implantation may be complex
Your PT may complain of blurry or double vision.
1- What is this condition?
2- What causes this condition?
3- What is the treatment?
| 1- Adie's/ Tonic Pupil|
- Drop Pilocarpine (cholinergic agent that causes pupil constriction)
2- No threat to vision
3- Damage to ciliary ganglion (post ganglionic parasympathetic fibers)
| You observe a young female with anisocoria who complains of photophobia and blurring while reading.|
1- What is this condition? How do you confirm it?
2- Is their a threat to vision?
3- What is the pathogenesis of this condition?
4- What is the treatment?
| 1- Bilateral irregular pupils that do not react to light but react to accomodation|
2- Is Specific to Neurosyphillis; treat for Neurosyphillis
|What is Arygll Robertson Pupil? (2)|
| 1- ptosis (upper eye lag), miosis (constriction), and anhidrosis (lack of sweat)|
2- Decrease in sympathetic activity in 1st, 2nd, or 3rd order neurons
• 60% vascular
• 35% tumors (Thyroid, Pancoast; lung tumor on the apex of the lungs
• Chest xray to rule out bronchogenic CA
• Head and/or neck CT to rule out vascular etiology
1- What is the triad for this condition?
2- What is the pathogenesis for this condition?
3- What is the etiology for this condition?
4- What should you exclude for this condition? (2)
|1- 3rd Nerve Palsies |
Acute or chronic decrease in CN III function
2- Compression, ischemia, or edema
Medical conditions: Diabetes, Hypertension, and giant cell arteritis.
3- Posterior communicating artery aneurysm until proven otherwise
4- Diabetes, Hypertension, and giant cell arteritis.
5-CN VI (lateral movement) and CN IV
Presence of inward rotation on attempted depression of the eye (shows intact fourth nerve (superior oblique) function)
You notice diplopia, ptosis, slight eye depression, and mydriasis with the PT. 1- What is this condition?
2- What causes this condition? What medical conditions can cause this (3)
3- Pts with painful acute isolated 3rd motor nerve palsy with papillary involvement are assumed to have what condition?
4- List the medical conditions that may cause isolated 3rd motor nerve palsy (3)
5- What nerve functions should be intact?
| 1- Cranial nerve IV palsy|
• Brainstem infarction
• Tumor (posterior fossa)
• Infection/ Inflammation
A little girl has a head tilt and an upper deviation of an eye. She also has a failure with adduction!
1- What is this condition?
2- What is the most common cause of this condition?
| 1- Cavernous sinus: infection of the cavernous sinus|
- staphylococcal infections of the face and sphenoid sinus
2- Decrease function of Cranial Nerves III, IV, VI
3- Early antibiotic administration; can quickly spread to other side
This PT reports that he has eye pain and a headache behind his eye. PT denies any trauma to his eye.
1- What is this condition? What usually causes this condition?
2- Which nerve functions are decreased with this condition?
| 1- Exopthalmos|
2- Thyroid Disease (Grave's)
| 1- What is the abnormal protruding of both eye called?|
2- What is the most common cause of this?
| 1- Periorbital (preseptal) cellulitis: Infection of soft tissues in front of the orbital septum|
2- Orbital (postseptal) cellulitis: Infection of fat and muscle within the orbit behind the eye
Explain the difference between peri-orbital (preseptal) and orbital (postseptal)?
|1- Fever, proptosis, restriction of extraocular movements, and swelling with redness of the lids|
2- Paranasal sinus infections (S pneumoniae, other streptococci, H influenzae and, less commonly, S aureus)
• Need early administration of antibiotics
• Nafcillin + 3rd generation cephalosporin
• Use Vancomycin if MRSA is suspected
4- Prompt treatment is needed to prevent optic nerve damage and spread to the cavernous sinus, meninges, and brain
*Orbital (postseptal) cellulitis
What are the characteristic findings in orbital cellulitis?(5)
2- What is the most common cause?
3- What is the treatment? (3)
4- Why is it treated so aggressively?
* What is this picture of?
|Periorbital (preseptal) cellulitis|| |
What is this condition?
|1- Vitreous Hemorrhage (bleeding from the retina and/or chorid)....Yes! Acute onset of vision loss occurs!|
2- Acute vision loss, floaters, and occasional bleeding from the eye.
3- Inability to see the details of the fundus even with a clear lens
4- Proliferative diabetic retinopathy (most common cause), Retinal detachment, Posterior vitreous separation, Retinal tears (with or without detachment), Retinal vein occlusions, Neovascualr age-related macular degeneration, Blood dyscrasias, Trauma, Subarachnoid hemorrhage
1- What is this condition? Is vision affected?
2- ***What are the three most common presentations in this condition?
3- What is a clue to diagnosis?
4- Predisposing factors?(10)
| 1- Amaurosis Fugax - Few minutes of unilateral blurred vision or blindness secondary to decreased retinal blood flow|
2- Carotid artery thromboembolic disease
| 1- Which ophthalmic pathology is commonly described as a curtain coming down over the eye?|
2- What thromboembolic disease is this usually indicative of?
| 1- Central Branch retinal artery occlusion; caused by embolus |
2- NO PAIN
3- Giant cell arthritis
4- Yes, if it affects the fovea
Your patient is complaining of sudden visual loss.
Your patient can only count fingers and can only see out the their temporal fields. In the temporal field In the retina you notice swelling.
1-What is this condition?
2- Is your PT experiencing pain?
3- What diagnosis must be considered in all pts > 55yo this condition?
4- Can your patient experience complete loss from this condition?
| 1- Reduce the risk of stroke|
2- Migraine, oral contraceptives, systemic vasculitis, congenital or acquired thrombophilia, and hyperhomocysterinemia
3- Could be an indication of internal carotid dissection
4- DM, hyperlipidemia, HTN
|Etiologies of Central Branch retinal Arterial block|
1- Why must carotid arteries and cardiac sources be evaluated?
2- What etiologies must be considered in younger pts?
3- What diagnosis must be considered if the pt has neck pain or recent trauma?
4- List the underlying diagnoses that must be considered in all pts.
|...||How is the presentation of CRAO different from that of branch retinal artery occlusion?|
|How is the presentation of CRAO different from that of branch retinal artery occlusion?|
Why does that seem logical?
Describe the ophthalmoscopic findings in retinal branch artery occlusion.
What underlying cardiac conditions might be the cause?
List the s/sx of temporal arteritis and explain its relationship to CRAO.
All pts with retinal artery occlusion must be screened for ______ and _______.
Abnormal results of what two labs would lead you to a diagnosis of Giant Cell
What other tests need to be ordered in younger pts?
List the components of immediate treatment.
What if the pt has GCA?
Transient Monocular Blindness
What is transient monocular blindness in plain English?
Why does it happen?