UWORLD Ophthalmology Step 2 CK

Gradual loss of peripheral vision over a period of years, and eventual tunnel vision.

High IOP.

Cupping of the optic disc with loss of peripheral vision.

Dx.

Open angle glaucoma

- African Americans

- FHx of glaucoma and diabetes

- BB (Timolol) eye drops effective initial management

- Laser trabeculoplasy adjunctive measure

___ infection lacrimal sac. Sudden onset of pain and redness in the medial canthal region.

Dacryocystitis

- fever, prostration, elevated leukocyte count

- Staph aureus, beta-hemolytic Strep

Systemic abx as tx

___ abscess located over the upper or lower eyelid. Caused by staph aureus. Localized red, tender swelling over eyelid.

Hordeolum

___ presents with sudden loss of vision and onset of floaters. Occurs in patients with diabetic retinopathy.

Vitreous hemorrhage

- fundus is hard to visualized

- pt with underlying medical condition conservative treatment (upright position during sleep, which enhances settling of the hemorrhage) is recommended)

High yield: Suspect ___ in patient with central scotoma, afferent pupillary defect, changes in color perception, and decrease in visual acuity.

Optic neuritis

- association with MS

___ is the most common cause of blindness in the industrialized nations.

Macular degeneration

Straight grid lines appear curved this dx usually affects fine visual acuity first.

Macular degeneration

- grid test = wavy vertical lines

- primary risk factor: INC age, smoking

- drusen deposits in the macula

TIA emboli occlude the distal ophthalmic artery the exam of the eye may reveal the presence of cholesterol particles called ___ bodies.

Hollenhorst bodies

___ occurs within 6 weeks of surgery patient has pain and decreased visual acuity. Exam shows swollen eyelids and conjunctiva, hypopyon, corneal edema and infection.

Postoperative endophthalmitis

- vitreous can be sent for gram stain and culture

- intravitreal abx can be injected or vitrectomy is done

Amaurosis fugal is characterized by visual loss that is transient and usually monocular. Dx.

Retinal emboli from carotid artery

- atherosclerosis

- once clot is displaced or breaks up blood flow is restored and vision returns

- noninvasive eval of the carotids

Acute onset of severe eye pain and blurred vision associated with N/V. Exam shows red eye with steamy cornea and moderately dilated pupil that is nonreactive to light.

Acute angle closure glaucoma

3 main categories of diabetic retinopathy.

1. Background or simple retinopathy - consists of microaneurysms, hemorrhages, exudates, and retinal edema

2. Pre-proliferative retinopathy - with cotton wool spots

3. Proliferative or malignant retinopathy - consists of newly formed vessels (neovascularization)

___ is performed for prevention of complications in diabetic retinopathy.

Argon laser photocoagulation

Optic __ occurs in 15% of patients with neurofibromatosis type 1.

Optic glioma

- progressive unilateral visual loss and dyschromatopsia

- axillary freckling + cafe au last spots

___ is typical for tuberous sclerosis.

Retinal hamartoma

Contact lens wearer presents with red eye and opacification and ulceration of the cornea typical feature of contact lens keratitis. Most often due to __ organism.

Pseudomonas and Serrate

- medical emergency can lead to corneal perforation, scarring, and permanent vision loss

- topical broad spectrum abx

___ is characterized by corneal vesicles and dendritic ulcers.

Herpes simplex keratitis

___ is a common age-related decrease in lens elasticity that leads to difficulty with near vision.

Presbyopia

___ sudden onset photopsia and floaters. "A curtain coming down over my eyes".

Retinal detachment

- Grey, elevated retina

- Laser therapy and cryotherapy

Funduscopic findings in central retinal vein occlusion

1. Venous dilation & tortuously due to venous occlusion

2. Scattered & diffuse hemorrhages due to backup of blood & INC resistance, leading to ischemic damage

3. Blood & thunder appearance due to diffuse hemorrhages

4. Cotton wool spots

5. Disk swelling

___ infection of the eye is the most common cause of corneal blindness in the US.

HSV infection

___ can cause severe, acute retinal necrosis associated with pain, keratitis, uveitis, and funduscopic findings of peripheral pale lesions and central retinal necrosis.

HSV and VZV

___ shows fluffy or granular retinal lesions near the retinal vessels associated hemorrhages in HIV pt.

CMV retinitis

- yellowish-white patches of retinal opacification and retinal hemorrhages

Mast cell stabilizing agents such as ___ and ___ are indicated for tx of allergic conjunctivitis.

olopatadine and azelastine

Tx viral conjunctivitis

Adenovirus and other viral URI

- no tx needed, warm or cold compresses

+/- antihistamines/decongestant drops

__ characterized by dendriform corneal ulcers and a vesicular rash in the trigeminal distribution.

Herpes zoster opthalmicus

- tx w/in 72 hours after eruption with high dose acyclovir reduces development of complications

Which medication should be avoided in acute glaucoma?

Atropine

- mydriatic agents can worsen glaucoma

Central retinal artery occlusion is emergently treated with?

Ocular massage and high-flow O2

Gold standard dx acute angle-closure glaucoma.

Gonioscopy

- sudden onset eye pain, HA, nausea

External hordeolum or stye is common staphylococcal abscess of the eyelid. Tx?

Warm compresses

I&D is performed if resolution does not being w/in next 48 hours.

RF for cataracts.

Advancing age

Diabetes

Smoking

Chronic sunlight exposure

Glucocorticoid use

Recurrent chalazion requires ___ exam high risk for an underlying (meibomian gland) carcinoma.

Histopathologic exam

- basal cell carcinoma is the most common malignancy of the lid margin

Sympathetic ophthalmia is characterized by damage of one eye (the sympathetic eye) after a penetrating injury to the other eye. This is due to an immunologic mechanism involving the recognition of ___.

"hidden antigens"

- break barriers uncovers hidden antigens, response to these causes cell-mediated autoimmune reaction