Comprehensive: Ophthalmology

Inability to focus on objects at a normal reading distance starting around age 40, natural loss of accommodation due to age

Presbyopia

Nearsightedness

Myopia

Farsightedness

Hyperopia

Reduction of vision in 1 eye due to eye-brain inability to work together

Amblyopia

"normal" refractive condition of the eye, clear vision

Emmetropia

Refractive errors horizontally and vertically

Astigmatism

Patient presents with bilateral hyperemia, clear to white stringy discharge, FB sensation, and mild photophobia. What is the most likely dx and tx?

Allergic conjunctivitis- treat with cromolyn 4% soln

Patient with a hx of chronic allergic conjunctivitis presents with watery to mucoid discharge and FB sensation of the eyes. On exam, large cobblestone papillae are seen on the upper tarsal conjunctiva. What is the most likely dx and tx?

Vernal keratoconjunctivitis- treat with cromolyn 4% soln

Patient presents with sudden onset mucopurulent discharge of the eyes with mild discomfort. What is the most likely dx and tx?

Bacterial conjunctivitis- treat with erythromycin 0.5% oint

Patient presents with sudden onset copious mucopurulent discharge of the eyes with mild discomfort. What is the most likely dx and tx?

Gonorrhoeae conjunctivitis- treat with Ceftriaxone IM + Doxy or Azithromycin + Bacitracin oint

Patient presents with gradual onset clear to mucopurulent discharge. Admits to recently being at Fyre festival where there were overcrowded areas with poor hygeine. What is the most likely dx and tx?

Chlamydia conjunctivitis- treat with Azithromycin + Bacitracin oint

Pooling seen on fluorescein stain. Most likely dx?

Contact lens conjunctivitis/Corneal ulcer

Patient presents with FB sensation and mild discomfort of eyes. Admits to sleeping in contact lens last night. What is the most likely pathogen and tx?

Pseudomonas- treat with Cipro/Levofloxacin ophth soln

Tx for fungal conjunctivitis

Natamycin 5% soln

What is the most common pathogen to cause viral (non herpetic) conjunctivitis?

Adenovirus

Dendrites seen on fluorescein stain. Most likely dx?

Viral, Herpetic conjunctivitis

Hutchinson's sign

Lesions on nose of Herpetic zoster ophthalmicus

Patient presents with chronic bilateral dry eyes and dry mouth. Patient was previously told he has "dry eye disease". What is the diagnosis and what test can be done?

Keratoconjunctivitis sicca- Schirmer test

Yellow bump/growth on the conjunctiva of eye that does NOT cross the cornea

Pinguecula

Triangular wedge on conjunctiva that DOES cross the cornea

Pterygium

Linear uptake seen on fluorescein stain. Most likely dx?

Corneal abrasion

Tx for corneal abrasion

Erythromycin oint (also update tetanus)

Diffuse punctate staining seen on fluorescein stain. Most likely diagnosis?

UV keratitis (actinic keratitis)

Tx for corneal ulcer

Levofloxacin/Ciprofloxacin soln

Unilateral pain, swelling, tenderness, redness, and purulent discharge coming from the lacrimal sac. Dx and pathogen?

Dacrocystitis caused by S. aureus

Chronic bilateral inflammation of lid margins. Red rimmed eyes with scales or granulation clinging to lashes "scruff"

Anterior blepharitis

Tx for anterior blepharitis

Erythromycin or Bacitracin oint

Tx for posterior blepharitis (1st line)

Warm compresses

Chronic bilateral inflammation of the meibomian glands. Entropion and frothy/greasy tears seen on exam.

Posterior blepharitis

Chronic granulomatous inflammation of meibomian gland seen as a hard, non-tender bump

Chalazion

Pathogen causing a hordeolum (stye)

S. aureus

Tx of hordeolum/stye (1st line)

Warm compresses

Tx of hordeolum/stye (2nd line)

Erythromycin

Tx of optic neuritis

IV methylprednisolone

Diplopia & lack of superior oblique function

Fourth nerve paralysis

Diplopia and lack of lateral rectus function

Sixth nerve paralysis

Disc swelling due to severe HTN, increased intracranial pressure, or Rx side effect

Papilledema

Infection of the anterior portion of the eyelid

Periorbital/Preseptal cellulitis

Tx for Periorbital/Preseptal cellulitis

Augmentin or Augmentin + Clinda or Augmentin + Bactrim

Tx for Posterior orbital cellulitis

IV Vanco + Ceftriaxone (d/c with clinda or bactrim + augmentin)

Pupil that constricts on accommodation but does NOT constrict when exposed to bright light

Argyll Robertson pupil

Pathogen causing Argyll Robertson pupil

T. pallidum (syphilis)

Patient presents with rapid vision loss of one eye. States that she was hit in the eye with a baseball before sxs began. Notes that it appears like a "curtain" is spreading across her visual field. Most likely dx?

Retinal detachment

CD < 50/mcL, yellow white patches seen on exam

Retinopathy cytomegalovirus

Tx for age related macular degeneration

Ranibizumab

Leading cause of blindness

Diabetic retinopathy

Flame hemorrhages, hard exudates, Cotton-wool spots, AV nicking, and copper/silver wires seen on fundoscopic exam. Most likely dx?

HTN retinopathy

Sea fan, salmon patches, and black sunburst seen on fundoscopic exam. Most likely dx?

Sickle cell retinopathy

Patient's mother states that she took a picture of her daughter and it showed one of her eyes with a "white reflex". Most likely dx?

Retinoblastoma

Tx for foreign body in eye

Erythromycin oint

Blood in anterior chamber

Hyphema

Blood between sclera and conjunctiva

Subconjunctival hemorrhage

Leukocytes in anterior chamber

Acute uveitis (iritis)

Sudden monocular vision loss, cherry read spot near macule, "box car" segmentation

Central artery occlusion

Sudden monocular vision loss, no pain or redness, "blood and thunder" retina

Central vein occlusion

Patient states that they experienced a sudden loss of vision in one eye, but it returned within a few minutes. Most likely dx?

Amaurosis fugax (ocular TIA)

IOP seen in glaucoma

> 22

Aqueous layer secreted by _______

Lacrimal gland

Mucin layer secreted by ______

Goblet cells

Lipid layer secreted by ______

Meibomian glands & glands of Zeis

Images focus behind the retina

Hyperopia

Images focus in front of the retina

Myopia

Most common color blindness

Red-green

Color blindness is tested using ____

Ishihara plates

Test used to assess for strabismus

Cover/Uncover test

- tropia: constant or transient?

Constant

- phoria: constant or transient?

Transient

Normal IOP

10-21

What is contraindicated in herpetic conjunctivitis?

Steroids