Ophthalmology Conditions and Emergencies Flashcards

Flashcards based on clinical ophthalmology notes, identifying key symptoms, diagnostic signs, and emergent versus non-emergent statuses.

Dacryoadenitis

Swelling and pain at outer upper lid (lacrimal gland); often with flu-like symptoms. Emergent? No

Dacryocystitis

Pain, redness, and swelling at medial canthus; purulent discharge from punctum; often in infants or older adults. Emergent? No

Keratoconjunctivitis sicca

Burning, foreign body sensation, intermittent blurring; decreased tear break-up time; often associated with Sjogren's or rheumatoid arthritis. Emergent? No

Pinguecula

Yellow-white, raised nodule on bulbar conjunctiva (nasal side); does NOT cross limbus. Emergent? No

Pterygium

Fleshy, triangular fibrovascular growth from conjunctiva onto cornea; often from UV exposure. Emergent? No

Conjunctivitis

Red eye with discharge: viral = watery + preauricular node; bacterial = purulent; allergic = itchy + stringy. Emergent? No

Blepharitis

Chronic lid margin crusting, scaling, redness; associated with seborrhea or rosacea. Emergent? No

Hordeolum

Acute, painful, red, localized swelling at lid margin (external stye) or internal (meibomian); tender to touch. Emergent? No

Chalazion

Chronic, painless, firm nodule in mid-lid; non-tender; from blocked meibomian gland. Emergent? No

Corneal abrasion

Sudden onset of sharp pain, photophobia, tearing; fluorescein shows epithelial defect (green stain). Emergent? No (but follow-up)

Corneal laceration

Full-thickness corneal wound with shallow anterior chamber; possible iris prolapse or Seidel sign (leak). Emergent? Yes

Corneal ulcer

White or grayish corneal infiltrate with overlying epithelial defect; severe pain, photophobia; often with hypopyon. Emergent? Yes

Corneal foreign body

Visible FB on cornea; rust ring may form; pain, tearing, FB sensation. Emergent? No (remove if superficial)

Viral keratitis (HSV)

Dendritic lesion on fluorescein (branching, terminal bulbs); decreased corneal sensation. Emergent? Yes

Bacterial keratitis

Suppurative, dense white infiltrate; often with hypopyon; contact lens wear is major risk factor. Emergent? Yes

Fungal keratitis

Indolent ulcer with feathery margins, satellite lesions; history of vegetable matter injury. Emergent? Yes

Episcleritis

Painless or mild discomfort; sectoral or diffuse red patch that blanches with phenylephrine; mobile with cotton swab. Emergent? No

Scleritis

Deep, boring, severe pain that radiates; violaceous hue; tender to palpation; may cause vision loss. Emergent? Yes (urgent)

Blue sclera

Thin, bluish-gray sclera; associated with osteogenesis imperfecta, Ehlers-Danlos. Emergent? No

Anterior uveitis (iritis)

Ciliary flush (limbal injection), photophobia, small or irregular pupil; cell and flare on slit lamp. Emergent? No (same-day refer)

Posterior uveitis

Vision loss, floaters, but no pain; retinal/choroidal infiltrates on exam. Emergent? No (refer)

Dislocated lens

Iridodonesis (tremulous iris); edge of lens visible in pupil; history of trauma or Marfan syndrome. Emergent? No

Vitreous detachment

Sudden onset of a single large floater (often horseshoe-shaped) and/or flashes; no vision loss; requires dilated exam to rule out tear. Emergent? No (but urgent exam)

Strabismus

Misalignment of eyes (esotropia, exotropia, hypertropia); constant or intermittent. Emergent? No

Amblyopia

Reduced best-corrected vision in one eye with no structural abnormality; caused by strabismus, anisometropia, or deprivation. Emergent? No

Myopia

Blurred distance vision; axial elongation; pinhole improves. Emergent? No

Hyperopia

Blurred near vision (in older) or asthenopia; young can accommodate. Emergent? No

Presbyopia

Difficulty reading small print after age $40$; improves with plus lenses. Emergent? No

Astigmatism

Blur at all distances; irregular corneal curvature; keratometry shows difference in meridians. Emergent? No

Nystagmus

Involuntary, rhythmic, repetitive eye movements; congenital or acquired (brainstem, cerebellum). Emergent? No

Open-angle glaucoma

Painless, progressive peripheral vision loss (tunnel vision); open angle; elevated IOP; cup-to-disc ratio $>0.5$. Emergent? No

Cataract

Painless, gradual blurring, glare, halos; loss of red reflex; visible lens opacity. Emergent? No

Macular degeneration (dry)

Drusen (yellow deposits) on fundus; gradual central vision loss; Amsler grid shows distortion. Emergent? No

Macular degeneration (wet)

Sudden or rapid central vision loss; metamorphopsia; subretinal fluid or hemorrhage; neovascular membranes. Emergent? Yes (urgent)

Retinal artery occlusion

Sudden, painless, profound monocular vision loss; cherry-red spot (fovea) with pale retina. Emergent? Yes

Retinal vein occlusion

Sudden, painless monocular vision loss; fundus shows 'blood and thunder' (diffuse hemorrhages, disc swelling). Emergent? No (same-day refer)

Retinal detachment

Painless 'curtain' or shadow over vision; flashes and floaters; visual field defect. Emergent? Yes

Retinitis pigmentosa

Night blindness (first symptom); progressive tunnel vision; bone-spicule pigmentation on fundus. Emergent? No

Hypertensive retinopathy

AV nicking, copper/silver wiring, cotton wool spots, flame hemorrhages; associated with uncontrolled hypertension. Emergent? No

Diabetic retinopathy (Non proliferative DR)

Microaneurysms, dot-blot hemorrhages, hard exudates; no neovascularization. Emergent? No

Diabetic retinopathy (Proliferative DR)

Neovascularization (disc or elsewhere), vitreous hemorrhage; vision loss can be sudden. Emergent? Yes

Papilledema

Bilateral optic disc swelling with blurred margins, hyperemia; spontaneous venous pulsations absent; vision initially spared. Emergent? No (urgent imaging)

Exophthalmos

Protrusion of the eyeball (Hertel exophthalmometry $>20\,mm$ or $>2\,mm$ asymmetry); often thyroid eye disease or orbital tumor. Emergent? No

Endophthalmos

Posterior displacement of the eye (sunken appearance); often after trauma, orbital fracture, or fat atrophy. Emergent? No

Orbital cellulitis

Proptosis, painful and restricted EOM, vision loss, fever; CT shows inflammation behind septum. Emergent? Yes

Chemosis

Boggy, edematous conjunctiva (gelatinous appearance); may be allergic or from orbital inflammation. Emergent? No (treat cause)

Intraocular foreign body

History of high-velocity trauma (hammering, grinding); possible visible FB on exam or CT; risk of endophthalmitis. Emergent? Yes

Orbital blow-out fracture

Diplopia on upgaze (entrapment), enophthalmos, infraorbital anesthesia ($V2$); history of blunt trauma. Emergent? No (urgent refer)

Blunt ocular trauma

Traumatic hyphema, angle recession, commotio retinae, or lid laceration; always rule out open globe. Emergent? Yes if hyphema or rupture

Globe rupture

Irregular pupil, hyphema, low IOP, Seidel sign (leaking fluid), obvious scleral/corneal laceration. Emergent? Yes

Subconjunctival hemorrhage

Painless, sharply demarcated, bright red blood under conjunctiva; no vision change; often after Valsalva or trauma. Emergent? No

Hyphema

Layered blood in anterior chamber; history of blunt trauma; risk of increased IOP and rebleeding. Emergent? Yes

Herpes zoster ophthalmicus

Vesicular rash in $V1$ dermatome (forehead, nose tip – Hutchinson's sign); may cause keratitis, uveitis. Emergent? Yes

Acute angle-closure glaucoma

Severe ocular pain, nausea/vomiting, blurred vision with halos; steamy cornea, fixed mid-dilated pupil, IOP $>40$. Emergent? Yes

Preseptal cellulitis

Eyelid erythema, edema, warmth, but NO proptosis, NO pain with EOM, NO vision loss; orbital septum intact. Emergent? No (oral/IV antibiotics)

Optic pathway lesion

Visual field defect (e.g., bitemporal hemianopia from chiasm, homonymous hemianopia from tract); relative afferent pupillary defect. Emergent? No (image)

Pupillary pathway lesion

Abnormal pupil size or reactivity (e.g., tonic pupil, Argyll Robertson, Horner's). Emergent? No (work up)

Pathologic nystagmus

Nystagmus from CNS lesion (brainstem, cerebellum, vestibular); often horizontal, vertical, or rotatory; may be present with other neuro deficits. Emergent? No (but image)

Optic nerve atrophy

Pale, flat optic disc; decreased vision; afferent pupillary defect (RAPD). Emergent? No

Argyll Robertson pupil

Small, irregular pupils; light-near dissociation (accommodates but does not react to light); associated with neurosyphilis. Emergent? No

Adie's tonic pupil

Large pupil; tonic, slow constriction to light; better constriction to near (light-near dissociation); benign. Emergent? No

Horner's syndrome

Triad: ptosis (mild), miosis (small pupil), anhidrosis (ipsilateral face). Emergent? No (image for cause)

Marcus Gunn pupil (RAPD)

Swinging flashlight test: affected pupil dilates paradoxically (instead of constricting). Emergent? No (work up)