USMLE World Ophthalmology
USMLE World Ophthalmology
Terms in this set (31)
How does acute angle glaucoma present?
acute onset of severe eye pain and blurred vision associated with nausea and vomiting. Exam reveals a red eye with steamy cornea and moderately dilated pupil that is non reactive to light
How does primary open angle glaucoma present?
(more common in African Americans)
ASx usually (initial stages)
Gradual loss of peripheral vision over a period of years, and eventual tunnel vision.
Exam: intraocular pressure high and there may be cupping of optic disc with loss of peripheral vision.
Tx: beta-blockers such as timolol eye drops are effective in the inital mgmt of the pt. laser trabeculoplasty is used as an adjunctive measure. If there is a continuous increase in intraocular pressure, surgical trabeculectomy is done.
What is presbyopia?
common age-related disorder that results from the loss of elasticity in the lens
- decreased elasticity prohibits accommodation of the lens, which is required in order to focus on near objects
- pts will hold reading material at a further distance
- age of onset usually in 40s
- can be improved w/ reading glasses
What neurologic conditions are seen in hyperosmolar hyperglycemic state without ketoacidosis?
common in Type 2 diabetics
- decreased consciousness
- blurred vision (caused by hyperglycemic hyperosmolarity, secondary to osmotic diuresis that causes dehydration and serum hyperosmolarity)
How does opitc neuritis present?
central scotoma, afferent pupillary defect, changes in color perception and decreased visual acuity
How does cataract present?
vision-impairing disease characterized by blurred vision and a glare
- due to progressive thickening of the lens
- caused by oxidative damage with aging
Tx: lens extraction
- extracapsular cataract extraction
- intracapsular cataract extraction
Cataracts doe not recur
How does age-related macular degeneration present?
progressive and bilateral loss of central vision
navigational vision is preserved
due to degenreation and atrophy of outer retina, retinal pigment epithelium, Bruch's membrane and choriocapillaries
What is Trachoma?
caused by Chlamydia trachomatis serotype A-C
Major cause of blindness worldwide
Active phase: follicular conjunctivitis and pannus (neovascularization) formation in the cornea.
Concurrent infection occurs in the nasopharynx, leading to nasal discharge
Tx: topical tetracycline or oral azithromycin ASAP
repeated infxn can cause scarring of the cornea
How does macular degeneration present?
Early findings: distortion of straight lines such that they appear wavy
- difficulties driving and reading
Risk factor: age, smoking
Fundoscopic exam: drusen deposits in the macula
How does allergic conjunctivitis present?
intense itching, hyperemia, tearing, conjunctival edema and eyelid edema
- acute hypersensitivity reaction caused by environmental exposure to allergens
How does CMV retinitis present?
yellow-white patches of retinal opacification and hemorrhages are diagnostic
NOT assoc with keratitis, conjunctivitis, and characterized by fundoscopic findings of hemorrhages and fluffy or granular lesions around the retinal vessels
How does central retinal vein occlusion present?
subacute monocular vision loss.
Dx: finding "blood and thunder" appearance on fundoscopic exam consisting of optic disk swelling, retinal hemorrhage, dilated veins, and cotton wool spots
How does central retinal artery occlusion present?
sudden, painless loss of vision in one eye, and the fundoscopic exam reveals pallor of the optic disk, a cherry red fovea, and boxcar segmentation of blood in the retinal veins
How does herpes zoster opthalmicus present?
dendriform corneal ulcers and a vesicular rash in the trigeminal distribution
- fever, malaise, and a burning, itching sensation in the periorbital region
Tx: start w/in 72hrs after eruption w/ high dose acyclovir reduces the development of complications.
How does gonococcal conjunctivitis present in infants?
copius amount of purulent drainage in newborns who are 2-5 days old
How does chlamydia trachomatis conjunctivitis present in infants?
milder than gonococcal conjunctivitis
presents more than five days after birth
How does chemical conjunctivitis present?
results from prophylactic silver nitrate eye drops, but is usually fairly mild
What can be used if suspect for intraocular foreign body?
dx with fluorescein examination
How does diabetic retinopathy present?
There are 3 main categories of diabetic retinopathy:
1) background/simple (microaneursyms, hemorrhages, exudates, retinal edema)
2) pre-proliferative (cotton wool spots)
3) proliferative or malignant (neovascularization)
visual impairment occurs with the development of macular edema
Tx: argon laser photocoagulation for the prevention of complications
What is dacryocystitis?
inflammatory changes in the medial canthal region of the eye
- infxn of lacrimal sac
- present with fever, prostration, and an elevated leukocyte count
Organisms: staph and beta-hemolytic strep
In HIV pts, what types of viral infxns can cause acute retinal necrosis?
HSV and VZV: Assoc with pain, keratitis, uveitis, and fundoscopic findings of peripheral pale lesions and central retinal necrosis
How does vitreous hemorrhage present?
sudden loss of vision and onset of floaters
- fundus is hard to visualize
occurs in pts with diabetic retinopathy
How does retinal detachment present?
sudden onset of photopsia (flashes of light) and floaters. Most classic description is "curtain coming down over my eyes"
How does amaurosis fugax present?
AKA retinal emboli
- visual loss that is usually monocular and transient
- sometimes described as "like a curtain falling down"
- fundoscopic exam: reveals zones of whitened, edematous retina following the distribution of the retinal arterioles.
How is acute glaucoma tx?
Narcotics for pain
increased intraocular pressure reduced with mannitol, acetazolamide, timolol, or pilocarpine
What tx should be avoided? Atropine-->can worsen glaucoma
How does postoperative endophthalmitis present?
most common form of endophthalmitis
occurs within six wks of surgery
pain and decreased visual acuity
Exam: swollen eyelids and conjunctiva, hypopyon, corneal edema and infection
How is central retinal artery occlusion tx?
EMERGENTLY tx with an ocular massage and high flow oxygen admin
- presents as painless loss of monocular vision
- risk factors: carotid artery disease, endocarditis, cardiac valvular disease, long bone fracture, hypercoaguable states, vasculitis, atrial myxoma
What is sympathetic ophthalmia?
AKA "spared eye injury"
characterized by immune-mediated inflammation of one eye (sympathetic eye) after a penetrating injury to the other eye
- presents as anterior uveitis, but panuveitis, papillary edema, and blindness may develop
pathophys: uncovering "hidden" antigens
How are styes tx?
AKA external hordeolum
- caused by common staph abscess of the eyelid
Tx: warm compresses
- I&D is performed if resolution does not begin in the next 48hrs
How does herpes simplex keratitis present?
corneal vesicles and dentritic ulcers (most common presentation)
- present complain of pain, photophobia, blurred vision, tearing, and redness
- recurrences precipitated by excessive sun exposure, outdoor occupation (as in this pt), fever, or immunodeficiency
Dx: epithelial scrappings show multi-nucleated giant cells
Tx: antiviral tx (oral or topical)
What is a complication of NF1?
- occurs in 15% of pts with this disease, mostly in children younger than 6yo
- presents as slowly progressive unilateral visual loss and dyschromatopsia
- exophthalmos present on physical exam
- optic disk may be normal, swollen, or atrophic
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