Ophthalmology Review: Physical Exam and Common Eye Conditions

A set of Question-and-Answer style flashcards covering ophthalmology physical exam, red-eye conditions, and common vision-threatening disorders described in the notes. Each card presents a clinical concept as a question and its concise answer for exam-style review.

What is the purpose of the swinging flashlight test during pupil examination?

To detect a relative afferent pupillary defect (RAPD) by observing how each pupil constricts (or fails to) when light is shone in each eye.

Which cranial nerves innervate the extraocular muscles according to the LR6 SO4 3 rule?

Lateral rectus is CN VI; Superior oblique is CN IV; all other extraocular muscles are CN III.

What is the normal intraocular pressure (IOP) range?

8–21 mm Hg.

What is orbital cellulitis and how is it typically managed?

An infection behind the orbital septum involving orbital fat and muscles; common in children; presents with fever, proptosis, painful EOMs; diagnosed with CT; treated with IV antibiotics; often requires hospital admission; surgery only if needed.

What is dacryocystitis and its typical management?

Inflammation/infection of the lacrimal sac due to nasolacrimal duct obstruction; often caused by Staph/Strep; managed with warm compresses, tear-free baby shampoo, topical antibiotics, and systemic antibiotics if cellulitis; dilation of the duct is rarely indicated.

What is dacryoadenitis and how might it present?

Inflammation of the lacrimal (cryptinh) gland; may be unilateral or bilateral; can be infectious or inflammatory; may have purulent discharge; culture if purulent; treat accordingly.

Define entropion and ectropion and the ocular consequences.

Entropion: eyelid turns inward, causing contact with the cornea and potential abrasion; treated with lubricants, possible Botox, or surgery. Ectropion: eyelid turns outward, leading to exposure and dryness; treated with lubricants, tape, or surgery.

Differentiate between a Hordeolum (stye) and a Chalazion.

Hordeolum: acute, painful, tender pustule on the eyelid margin; treat with warm compresses and topical antibiotics; avoid squeezing. Chalazion: noninfectious, hard granuloma; not painful; may resolve spontaneously; may require incision and curettage if bothersome.

What is blepharitis and its typical management?

Inflammation of the eyelid margins and meibomian glands; treat with thorough lid hygiene using baby shampoo and warm washcloth; topical antibiotics if needed; meibomian gland dysfunction can contribute to dry eye.

Describe pterygium and its primary management.

Wing-shaped vascular overgrowth of conjunctiva extending toward the cornea from the nasal side, usually due to UV exposure; manage with lubricants and protection; surgical excision if it affects vision.

How are allergic, viral, and bacterial conjunctivitis typically distinguished and treated?

Allergic: bilateral watery, with triggers; treat with oral antihistamines and ophthalmic antihistamines; avoid triggers. Viral: unilateral onset, watery with minimal purulence; self-limited; supportive care and hygiene. Bacterial: purulent discharge with morning eye crusting; treat with topical antibiotics; if contact lens wear, cover Pseudomonas with a fluoroquinolone and treat both eyes.

What is keratoconjunctivitis sicca (dry eye) and how is tear film maintained?

Dry eye disease from tear film instability; involves lipid (meibomian), aqueous (lacrimal), and mucin (goblet cells) layers; manage with frequent artificial tears (often hourly), topical cyclosporine, and possibly punctal plugs; eyelid hygiene helps.

What are the key differences between scleritis and anterior uveitis in presentation and urgency?

Scleritis: very deep, boring pain with marked photophobia and severe redness; can threaten the globe; urgent referral. Anterior uveitis: painful red eye with ciliary flush, photophobia, decreased vision, and possible hypopyon; urgent ophthalmology referral.

What is posterior uveitis and how does it typically present?

Painless red eye with vision loss; can be associated with systemic diseases like sarcoidosis or MS; urgent ophthalmology referral.

How is a corneal foreign body typically managed when visible on exam?

Remove the foreign body (often with sterile tools or a tiny needle), irrigate if needed, check for rust ring if metallic, stain with fluorescein, and treat with an ophthalmic antibiotic; update tetanus; refer if large or central or if vision is threatened.

What are the steps for managing a corneal foreign body that is not easily visible but suspected?

Use fluorescein staining to identify the lesion; examine under Wood lamp or slit lamp; remove if possible; treat with antibiotic; consider ENT referral if removal is difficult.

Describe corneal abrasion management and post-care precautions.

Painful red eye with a history of trauma; treat with ophthalmic antibiotic; avoid contact lens until healed; consider fluoroquinolone if contact lens wearer; analgesia as needed; refer if large or not improving within 48 hours due to risk of keratitis/ulcer.

What characterizes herpetic keratitis and its treatment approach?

Dendritic (branching) corneal lesions visible with fluorescein; treat with topical antiviral and systemic antiviral (e.g., acyclovir); avoid early corticosteroids; may require a bandage contact lens; untreated can lead to blindness.

What is central retinal artery occlusion (CRAO) and its hallmark sign?

Acute, unilateral, painless loss of vision; often with a cherry red spot on a pale macula; urgent revascularization is needed to attempt vision preservation.

How does central retinal vein occlusion (CRVO) typically present and how is it managed?

Unilateral, painless vision loss with subacute onset; retinal edema, hemorrhages, and cotton-wool spots; urgent ophthalmology referral for evaluation and management; treatment focuses on underlying causes and vision preservation.

What are the classic symptoms of retinal detachment and the recommended action?

Flashes of light, floaters, and a curtain-like loss of vision; emergent ophthalmology referral for possible laser, cryotherapy, or pneumatic retinopexy to reattach the retina.

Explain age-related macular degeneration (AMD) and the role of the Amsler grid in its evaluation.

AMD is the leading cause of irreversible central vision loss; dry AMD has central vision loss with possible scotomas; wet AMD involves neovascularization. Amsler grid detects central distortions; dry AMD is less easily treated, while wet AMD can be slowed with anti-VEGF injections.

How are dry and wet AMD treated or managed?

Dry AMD: antioxidants, smoking cessation, magnification; difficult to treat directly. Wet AMD: anti-VEGF injections to slow neovascularization; vision preservation strategies.

Distinguish open-angle glaucoma from acute angle-closure glaucoma and their treatments.

Open-angle glaucoma: gradual peripheral vision loss; managed with topical prostaglandin analogs and other IOP-lowering agents and sometimes laser therapy. Acute angle-closure glaucoma: sudden severe pain, halos, fixed mid-dilated pupil, rapid IOP rise; urgent treatment with acetazolamide and laser peripheral iridotomy.

What are common retinal changes in hypertensive retinopathy and their management?

Chronic: copper wiring, silver wiring, AV nicking; management focuses on blood pressure control. Acute hypertensive retinopathy is a hypertensive emergency with signs like optic disc edema and cotton-wool spots; requires urgent systemic management and neuroimaging as indicated.

What injuries are associated with orbital blowout fractures and how are they managed?

Fracture of the orbital floor causing diplopia and possible muscle entrapment or nerve injury; management involves CT imaging and involvement of maxillofacial surgery; treatment may require surgical repair.

Describe globe rupture and the initial management steps in the ED.

Ocular emergency; stabilize patient first; apply a rigid eye shield if rupture suspected; avoid pressure, fluorescein, or pressure patch; obtain imaging (CT) and intravenous antibiotics; expedite ophthalmology care.

How is hyphema managed and when is urgent care required?

Blood in the anterior chamber from ocular trauma; protect the eye with a shield, keep the patient upright, urgent ophthalmology involvement; may require surgical drainage or monitoring for secondary glaucoma.

What is amblyopia and how is it screened for in strabismus?

Functional reduction in visual acuity due to improper visual development, often from strabismus or refractive error; screen with corneal light reflex and cover-uncover tests; treat with glasses, occlusion therapy, pharmacologic blunting, Botox, or surgery as appropriate.

What is papilledema and why is urgent neuroimaging indicated?

Optic disc swelling due to increased intracranial pressure; presents with headache, nausea, vomiting, systemic signs; requires urgent imaging to determine underlying cause and prevent vision loss.

What is optic neuritis and its typical clinical context and treatment?

Rapid unilateral progressive vision loss with pain on eye movements; RAPD; often associated with MS; treated with IV corticosteroids; most patients recover vision in 2–3 weeks.