JC CM EENT rapid fire

medial rectus function

adduction

lateral rectus function

abduction

superior rectus

elevates

adducts

intorts

inferior rectus fx

depresses

adducts

extorts

superior oblique fx

depresses

intorts

abducts

inferior oblique fx

elevates

abducts

extorts

inferior rectus and superior rectus →

depresses

superior rectus and inferior oblique →

elevates eye

_ offsets tendency of oblique muscles to abduct eyes

medial rectus

strabismus definition

non-conjugate gaze of one or both eyes

phoria vs. tropia

weakness

extreme weakness

strabismus directions

eso - nasal deviation of non-fixating (abnormal) eye

exo - temporal

hyper - up

hypo - downward

latent strabismus/phoria definition

intermittent

present when pt is tired / when fusion is broken

manifest strabismus (tropia) definition

constant

present even when fixation interrupted

retinopathy of prematurity cause

premature baby = no blood vessels to retina

→ neovascularization (new vessels are weak/fragile)

→ retinal scarring

cause of retinopathy of prematurity

excessive oxygen admin

leukochoria → what finding

white reflex

cause of leukochoria

retinoblastoma

cataracts

hordeolum definition

local infx or inflammation of eyelid

painful, erythematous

external hordeolum is infx of

eyelid margin

(sebaceous gland of hair/zeis)

hordeolum tx

warm compress bid x 2 wks

bacitracin / erythomycin ointment

internal hordeolum is an infx of

meibomian glands

untreated internal hordeolum →

blepharitis

chalazion

blepharitis definition

painful cellulitis of eyelid and lid margin

chalazion definition

obstruction of meibomian gland

→ lipid material into soft tissue of eyelid w painless granuloma formation

tx of internal hordeolum

warm compress bid x 2 weeks

recurrent chalazia tx

tetracycline

#1 cause of blepharitis

staph aureus (internal hordeolum)

causes of blepharitis

1. internal hordeolum

2. rosacea

3. seborrhea

4. trauma to lid

blepharitis sx

telangiectatic vessels

lashes crusty/gone

blepharitis tx

lid hygiene

warm compress

natural tears

erythromycin or bacitracin ointment

unresponsive = tetra or doxy

ectropion definition

turning out of eyelid

ectropion cause

congenital

aging

allergy

chemo

mechanical

scarring

facial nerve palsy

ocular rosacea

entropion definition

turning in of eyelid

cause of entropion

congenital

aging

scarring

trachoma (chlamydia)

facial nerve spasm

entropion → ?

trichiasis

(eyelashes rubbing on cornea)

ptosis definition

drooping of upper lid

causes of unilateral ptosis

neuro:

CN III (controls EOM levator palpebrae)

horners syndrome

cause of bilateral ptosis

muscular/myopathic cause

(myasthenia gravis)

proptosis (exopthalmos) definition

protrusion of globe from orbit

bilateral proptosis (exophthalmos) cause

graves disease

acute unilateral proptosis cause

infx

vascular disorder

(hemorrhage, fistula, cavernous sinus thrombosis)

chronic unilateral proptosis cause

tumor

viral conjunctivitis is assoc with

URI

preauricular adenopathy (adenovirus)

viral conjunctivitis dx test

adenoplus

viral conjunctivitis s/sx*

starts in one eye → spreads (bilateral)

lid swelling

conjunctival redness

chemosis

burning ears/gritty/tears

viral conjunctivitis tx

cold compress

lubrication drops

severe = steroids

good handwashing

dont share towels

allergic conjunctivitis is seen in pts with?

atopy

allergic conjunctivitis s/sx*

bilateral at start

itching**/foreign body sensation in eye

no discharge

velvety papillae/cobblestoning in upper tarsus

less involvement of hair follicles of lashes

vernal keratoconjunctivitis definition

severe chronic form of allergic conjunctivitis that affects cornea specifically around limbus

vernal keratoconjunctivitis s/sx

worse upon awakening/springtime

discomfort

blepharospasm

photophobia

mucous discharge

allergic conjunctivitis tx

avoid allergen

cold compress

antihistamines

giant papillary conjunctivitis: mast cell stabilizers

bacterial conjunctivitis cause*

staph

strep

h. flu

bacterial conjunctivitis s/sx

sudden onset, unilateral → bilateral

purulent discharge

matting if lashes in AM

conjunctival injection

papillary reaction

tearing and irritation

bacterial conjunctivitis tx

polymyxin-trimethoprim drops (broad spectrum abx)

hyper-acute bacterial conjunctivitis cause*

gonococcus (gonorrhea)

hyper-acute bacterial conjunctivitis s/sx

sudden onset, bilateral

tender preauricular lymphadenopathy

redness

amblyopia

chemosis

lid swelling

LOTs of purulent discharge

hyper-acute bacterial conjunctivitis tx

urgent referral, hospitalization

abx

leading preventable cause of blindness worldwide

trachoma

trachoma cause*

chlamydia trachomatis

trachoma s/sx

intense thickening/swelling of eyelids

production of mucus

→ scarring of inner eyelids, entropion, trichiasis

uveitis definition

inflammation in anterior chamber

(iris, ciliary body, choroid)

uveitis s/sx*

watery d/c

photophobia

blurred vision

uveitis dx*

slit lamp exam

ciliary flush

uveitis tx

pain control

abx

referral

HLA b27 antigen is assoc with

uveitis/iritis

IBD

reiters syndrome

psoriatic arthritis

ankylosing spondylitis

cataracts cause*

oxidative damage (senile cataracts)

trauma

inflammation

radiation

congenital

cataracts RF

age

smoking/alc/malnutrition

sunlight

metabolic syndrome

DM

steroids

cortical cataracts forms in _ of lens

peripheral portion

does not degrade vision a lot

nuclear cataracts forms in _ of lens

middle

progress slowly w/ gradual loss of distance vision

posterior subscapular cataracts forms in the _ of lens

back/posterior side

progresses quickly → severe problems with glare

#1 reason people stop driving?

posterior subscapular cataracts

immature cataracts

lens opacity

mature cataracts

loss of red reflex

cataracts tx

surgery

(remove cataract and implant intraocular lens)

reading glasses after

what drug raises risk of floppy iris syndrome

alpha 1 blocker (-zosins)

diabetic retinopathy is a _ complication of DM

microvascular

which DM has more cases of diabetic retinopathy

DM II

which DM has more severe complications from diabetic retinopathy

DM I

what accelerates pregnancy progression in DM 1?

pregnancy

are pts with gestational DM INC risk of diabetic retinopathy?

no

diabetic retinopathy is more about high BS or BP?

BS

nonproliferative diabetic retinopathy (NDPR) sx*

cotton wool spots

hard exudates

retinal edema

microaneurysms of retinal vessels

intraretinal hemorrhages

proliferative retinopathy (PDR) cause

advanced stage of diabetic retinopathy

ischemia → neovascularization (weak vessels) → fibrosis → bleeding /retinal detachment

proliferative retinopathy (PDR) s/sx*

decreased visual acuity

floaters

sudden loss of vision (curtain falling)

prevention of diabetic retinopathy

tight blood sugar control

lipid control

screening for diabetic retinopathy

DM 1: 3-5 yrs after diagnosis then annual

DM 2: annual once diagnosed

hypertensive retinopathy is a _ disease

macrovascular

hypertensive retinopathy definition

HTN damages the eye major arterial supply

→ microemboli in retina

HTN accelerates which conditions

diabetic retinopathy

macular degeneration

glaucoma

stages of hypertensive retinopathy

mild: retinal artery narrowing, AV nicking

mod: cotton wool spots, hard exudates

severe: papilledema

most common cause of blindness in industrialized countries and #1 cause of loss of vision in US

macular degeneration

macular degeneration definition

degeneration of macula (central part of retina)

→ lost central vision

central vision/cones

bright light

high contrast

color vision

rods

night vision

peripheral vision

macular degeneration RF

age >50

smoking

fh

female

cvd (stroke, mi, angina)

cataract surgery

dry macular degeneration cause

changes that impede flow of nutrients

waste products b/w photoreceptor and retinal pigment layer

dry macular degeneration finding*

subretinal drusen build up near macula

(glows golden-orange fluorescence)

wet macular degeneration

growth of abnormal vessels in subretinal space that leaks

prevention/tx of macular degeneration

no proven tx

vascular endothelial growth factor inhibitors

inc lutein, vit c + e, zinc, copper