Transcript Ophthalmology Review for Year 4 Med Students 2014

Trauma
And red eye
When a patient arrives at the ER with a
supposed alkali chemical burn to the eye,
what is your first action,
a)
b)
c)
d)
Check vision
Check pupils for afferent pupillary defect
Irrigate eye with normal saline
Check PH of the conjunctival fornix
When a patient arrives at the ER with a
supposed alkali chemical burn to the eye,
what is your first action,
a)
b)
c)
d)
Check vision
Check pupils for afferent pupillary defect
Irrigate eye with normal saline
Check PH of the conjunctival fornix




Chemical burn :
Acid , coagulate proteins and inhibit further
corneal penetration
Alkali worse prognosis
never try to neutralize
If a ruptured globe is suspected, the first
action to take is to:
a)
b)
c)
d)
Shield the eye
Patch the eye
Give topical or systemic antibiotics
Assess the vision
If a ruptured globe is suspected, the first
action to take is to:
a)
b)
c)
d)
Shield the eye
Patch the eye
Give topical or systemic antibiotics
Assess the vision




R/o intraocular foreign body with orbital CT
scan, specially in metal on metal hammering
NPO
IV antibiotic
Tetanus status
Need to be referred,






Decreased vision
Shallow anterior chamber
Hyphema
Abnormal pupil
Ocular misalignment
Retinal damage
The best study to evaluate a patient with
intraocular foreign body is
a)
b)
c)
d)
Orbital ultrasound
MRI scan of the orbits
CT scan of the orbits
Plain film of the skull
The best study to evaluate a patient with
intraocular foreign body is,
a)
b)
c)
d)
Orbital ultrasound
MRI scan of the orbits
CT scan of the orbits
Plain film of the skull
Management of orbital floor fracture
Is a surgical emergency that requires immediate
repair
b) Includes surgical repair only for persistent diplopia
add/or cosmetic issues.
c) Does not require ophthalmology consultation
because associated ocular damage is rare
d) Always includes topical and systemic antibiotics
a)
Management of orbital floor fracture
Is a surgical emergency that requires immediate
repair
b) Includes surgical repair only for persistent
diplopia add/or cosmesic issues.
c) Does not require ophthalmology consultation
because associated ocular damage is rare
d) Always includes topical and systemic antibiotics
a)
Treatment:
No cough , no nose blowing
Systemic AB, if sinusitis
Surgery if fx more than 50% of the floor,
diplopia not improving, enophthalmos
more than 2 mm,
There might be a picture of a kid with white
eye, who can’t look up., blow out fracture
In the case of the contact lens
wearer with this cornea
Instills antibiotics, patch the eye, and reexamine
in 24 hours
b) Antibiotic coverage for gram-positive organism
is important.
c) refer to an ophthalmologist only if the case is
complicated by a corneal infiltrate.
d) The risk of ulceration is significantly higher than
in not –contact Lens wearer
a)
In the case of the contact lens
wearer with this cornea
Instills antibiotics, patch the eye, and reexamine
in 24 hours
b) Antibiotic coverage for gram-positive organism
is important.
c) refer to an ophthalmologist only if the case is
complicated by a corneal infiltrate.
d) The risk of ulceration is significantly higher
than in not –contact Lens wearer
a)



No patch in contact lens induced abrasions ,
risk of pseudomonas ulcer
No patch for simple abrasion less than
10mm,
Never prescribe topical anesthetics,
Proper treatment for a corneal abrasion
includes which of the following?
a)
b)
c)
d)
Topical corticosteroids
A tight patch over the eye for 48 to 72 hours
Topical anesthetic for less then 12 hours
only
Oral analgesic if necessary
Proper treatment for a corneal abrasion
includes which of the following?
a)
b)
c)
d)
Topical corticosteroids
A tight patch over the eye for 48 to 72 hours
Topical anesthetic for less then 12 hours
only
Oral analgesic if necessary
Conjunctival injection with discharge
a)
b)
c)
d)
Should be treated with a topical antibiotic even
if discharge is watery.
Can be treated with a topical steroid initially if
inflammation is significant.
Should be treated with parenteral antibiotic if
gonococcal.
Is probably of viral origin in the presence of
prominent itching symptoms
Conjunctival injection with discharge
a)
b)
c)
d)
Should be treated with a topical antibiotic even
if discharge is watery.
Can be treated with a topical steroid initially if
inflammation is significant.
Should be treated with parenteral antibiotic
if gonococcal.
Is probably of viral origin in the presence of
prominent itching symptoms.






Papillae
Allergic conjunctivitis
Bacterial conjunctivitis
Follicles
Viral conjunctivitis
Chlamydial conjunctivitis
Remember:
Gonococcal conjunctivitis should be treated
with parenteral antibiotic.
Why?
Risk of corneal perforation
10. which of the following is not characteristic
of acute angel closure glaucoma
a)
b)
c)
d)
High IOP
Mild eye pain
Decreased vision
A fixed and dilated pupil
10. which of the following is not characteristic
of acute angel closure glaucoma
a)
b)
c)
d)
High IOP
Mild eye pain
Decreased vision
A fixed and dilated pupil
Primary angle closure glaucoma, risk factors
Hyperopia
Age>70
Female
Family history
Asian, Inuit people
Mature cataract
Shallow anterior chamber
Pupil dilation
What is your next plan:
 Refer to ophthalmologist for laser iridotomy
What would be the next plan
 Laser iridotomy
 Aqueous suppression with BACH
 Miotics to reverse the pupillary block
11. The finding that best distinguishes orbital
cellulites from preseptal cellulitis is,
a)
b)
c)
d)
Profound skin erythema with swelling
extending above the eyebrow
Limited ocular motility
Fever
Pain around the eye
11. The finding that best distinguishes orbital
cellulitis from preseptal cellulitis is,
a)
b)
c)
d)
Profound skin erythema with swelling
extending above the eyebrow
Limited ocular motility
Fever
Pain around the eye




Ocular motility
Vision
RAPD
Sinusitis can cause orbital cellulitis and
trauma , skin abrasoin any skin lesion can
cause preseptal.
All of the following are part of the evaluation
and management of orbital cellulitis except
a)
b)
c)
d)
Ophthalmologic consultation
Orbital CT scan
Blood culture
Outpatient administration of oral antibiotics
in an immunocompetent patient
All of the following are part of the evaluation
and management of orbital cellulitis except
a)
b)
c)
d)
Ophthalmologic consultation
Orbital CT scan
Blood culture
Outpatient administration of oral
antibiotics in an immunocompetent
patient



Request stat ophthalmology and ENT
consultations to rule out a life–threatening
fungal infection (mucoromycosis)
Diabetic patient with ketoacidosi,
Frozen globe, + RAPD



Request stat ophthalmology and ENT
consultations to rule out a life–threatening
fungal infection (mucoromycosis)
Diabetic patient with ketoacidosi,
Frozen globe, + RAPD
12. which of the following is least consistent
with the diagnoses of temporal arteritis?
a)
b)
c)
d)
Jaw claudication
diabetes mellitus
age over 65 years
Scalp or forehead tenderness
12. which of the following is least consistent
with the diagnoses of temporal arteritis?
a)
b)
c)
d)
Jaw claudication
diabetes mellitus
age over 65 years
Scalp or forehead tenderness
In a patient who presents with unilateral visual
loss with scalp tenderness
a)
b)
c)
d)
A temporal artery biopsy should be
performed before steroids are started.
An erythrocyte sedimentation rate(ESR)
should be obtained immediately.
Involvement off the second eye is rare.
Temporal arthritis is unlikely if the patient is
older than 65.
In a patient who presents with unilateral visual
loss with scalp tenderness
a)
b)
c)
d)
A temporal artery biopsy should be
performed before steroids are started.
An erythrocyte sedimentation rate(ESR)
should be obtained immediately.
Involvement off the second eye is rare.
Temporal arthritis is unlikely if the patient is
older than 65.
In giant cell arteritis all of the following are true
except
A low or normal sedimentation rate does not
exclude the diagnoses
b) The most common cranial nerve paralysis that
occur involves the third cranial nerve.
c) A deficit in choroidal circulation is typically
seen on fluorescein angiography.
d) This condition typically affects people under
age 60.
a)
In giant cell arteritis all of the following are true
except
A low or normal sedimentation rate does not
exclude the diagnoses
b) The most common cranial nerve paralysis that
occur involves the third cranial nerve.
c) A deficit in choroidal circulation is typically
seen on fluorescein angiography.
d) This condition typically affects people under
age 60.
a)






F > 60 y/o
Abrupt monocular loss of vision, pain over
temporal artery , jaw claudication, scalp
tenderness, PMR, constitutional
Diagnosis : temporal artery biopsy
Treatment high dose steroid, start immediately ,
before the biopsy
Hx: Jaw claudication and diplopia,
On exam: temporal a. beading, prominence of a.
tenderness
13. Possible causes for sudden Visual loss
include all of following except
a)
b)
c)
d)
Temporal arteritis
Retinal detachment
Glaucoma
Nonarteritic optic neuropathy
13. Possible causes for sudden Visual loss
include all of following except
a)
b)
c)
d)
Temporal arteritis
Retinal detachment
Glaucoma
Nonarteritic optic neuropathy
. The best method for evaluating a 50-year-old
patient for best-corrected vision without his
or her glasses is,
a)
b)
c)
d)
Near card
Distance chart with pinhole
Distance chart with both eye open
Magazine or newspaper
. The best method for evaluating a 50-year-old
patient for best-corrected vision without his
or her glasses is,
a)
b)
c)
d)
Near card
Distance chart with pinhole
Distance chart with both eye open
Magazine or newspaper
What mechanism of action do cycloplegic
use to relieve pain?
a)
b)
c)
d)
Topical anesthetic
Paralysis of pupillary dilation
Paralysis of ciliary spasm
Decrease production of inflammatory cells
in anterior chamber
What mechanism of action do cycloplegic
use to relieve pain?
a)
b)
c)
d)
Topical anesthetic
Paralysis of pupillary dilation
Paralysis of ciliary spasm
Decrease production of inflammatory cells
in anterior chamber
This patient presents with sudden unilateral
vision loss. All of the following are treatment
options except
a)
b)
c)
a)
Continues digital massage of the globe to
dislodge an embolus
Topical beta blockers
AC paracenthesis by an
ophthalmologist
Re-breathing CO2
This patient presents with sudden unilateral
vision loss. All of the following are treatment
options except
a)
b)
c)
a)
Continues digital massage of the globe to
dislodge an embolus
Topical beta blockers
AC paracenthesis by an
ophthalmologist
Re-breathing CO2




Emboli from carotid a.
Emboli heart( arrhythmia, valvular,
endocarditis)
Thrombosis
Temporal arteritis
In the elderly the most come source of emboli
to ophthalmic or retinal arterioles is
a)
b)
c)
d)
Fibrin or cholesterol from an ulcerated
carotid plaque.
A calcified heart valve
Fibrin -platelet emboli from mitral valve
prolapse
Fibrin- platelet emboli from the aorta
In the elderly the most come source of emboli
to ophthalmic or retinal arterioles is
a)
b)
c)
d)
Fibrin or cholesterol from an ulcerated
carotid plaque.
A calcified heart valve
Fibrin -platelet emboli from mitral valve
prolapse
Fibrin- platelet emboli from the aorta
All of the following statements
regarding this trauma case are
true except
a)
b)
c)
d)
It is the result of a tear in an iris vessel.
It can be associated with other ocular injuries.
It is treated with the antibiotics and routine
activities.
It should be referred to ophthalmologist.
All of the following statements
regarding this trauma case are
true except
a)
b)
c)
d)
It is the result of a tear in an iris vessel.
It can be associated with other ocular injuries
It is treated with the antibiotics and routine
activities.
It should be referred to ophthalmologist.
Risk of re-bleed highest on days 2-5 , resulting in
 Increased IOP, corneal staining, iris necrosis,
 Never asiprin ,
risk of re-bleed, no valsalva
Herpes zoster involving the ophthalmic
devision of cranial nerve V is more likely to
have ocular involvements if
a)
b)
c)
d)
The tip of the nose is involved
The upper lid is involved
The lower lid is involved
Either lid margin is involved
Herpes zoster involving the ophthalmic
devision of cranial nerve V is more likely to
have ocular involvements if
a)
b)
c)
d)
The tip of the nose is involved
The upper lid is involved
The lower lid is involved
Either lid margin is involved

In presence of Hutchinson sign there is significantly
high risk of eye involvement.




Treatment
Oral antiviral
In cases of conjunctival involvement ,erythromycin
Refer to ophthalmologist and steroid should be
prescribed by ophthalmologist.
A 30 y/o M, presents with
redness, pain photophobia and
decreased vision. If this is the
photo of his eye,the next step is
a)
b)
c)
d)
Patch the eye and give assurance of
spontaneous resolution
Prescribed a topical corticosteroid
Prescribed a topical antibiotic
ointment
Referral to an ophthalmologist
A 30 y/o M, presents with
redness, pain photophobia and
decreased vision. If this is the
photo of his eye,the next step is
a)
b)
c)
d)
Patch the eye and give assurance of
spontaneous resolution
Prescribed a topical corticosteroid
Prescribed a topical antibiotic
ointment
Referral to an ophthalmologist
Treatment by ophthalmologist
 Antiviral preferably oral ,
 Steroid not at the beginning and with caution
, by the ophthalmologist
Lid laceration repair should include
a)
b)
c)
d)
Assessment of possible canalicular injury
Foreign body removal
Tetanus prophylaxis
All of the above
Lid laceration repair should include
a)
b)
c)
d)
Assessment of possible canalicular injury
Foreign body removal
Tetanus prophylaxis
All of the above


Lid margin laceration
Medial lid laceration with canalicular involvement
Sunconjunctival hemorrhages
a)
b)
c)
d)
Are usually a sign of underlying
hematologic or coagulation abnormalities,
even in the absence of retinal
hemorrhages that require extensive
Systemic workup.
Are sometimes associated with severe
pain and or loss of vision.
Require cessation of any NSAID or
Systemic anticoagulant for resolution.
Resolve spontaneously in 2-3 weeks.
Sunconjunctival hemorrhages
a)
b)
c)
d)
Are usually a sign of underlying
hematologic or coagulation abnormalities,
even in the absence of retinal
hemorrhages that require extensive
Systemic workup.
Are sometimes associated with severe
pain and or loss of vision.
Require cessation of any NSAID or
Systemic anticoagulant for resolution.
Resolve spontaneously in 2-3 weeks.
Prolonged use of topical ophthalmic
anesthetics can cause
a)
b)
c)
d)
Iritis
Corneal damage
Open-angle glaucoma
Reactivation of a latent herpes simplex virus
infection
Prolonged use of topical ophthalmic
anesthetics can cause
a)
b)
c)
d)
Iritis
Corneal damage
Open-angle glaucoma
Reactivation of a latent herpes simplex virus
infection
Side effects of topical steriod
corneal fungal ulcers
Cataracts
Open-angle glaucoma
Progression of herpes keratitis, dendrites
Treatment of a chalazion ,
which presents as an acute
tender swelling of the lid usually
a)
b)
c)
d)
Requires incision and drainage
Requires topical antibiotics
Requires a short course of systemic
antibiotics
Includes warm compresses and lid
hygiene for 2 weeks
Treatment of a chalazion ,
which presents as an acute
tender swelling of the lid usually
a)
b)
c)
d)
Requires incision and drainage
Requires topical antibiotics
Requires a short course of systemic
antibiotics
Includes warm compresses and lid
hygiene for 2 weeks
Still a chalazion
Neonatal Chlamydial conjunctivitis
a)
b)
c)
d)
Has become rare the advent of silver nitrate
prophylaxis
Occurs only after 21 days of age
Maybe treated with topical erythromycin
alone
Requires two weeks of systemic
erythromycin for effective treatment
Neonatal Chlamydial conjunctivitis
a)
b)
c)
d)
Has become rare the advent of silver nitrate
prophylaxis
Occurs only after 21 days of age
Maybe treated with topical erythromycin
alone
Requires two weeks of systemic
erythromycin for effective treatment

Ophthalmia neonatarum

Toxic , 1 day, silver nitrate or erythromycin ,
no treatment neede
Gonococcal 5-7 days, is the most serious
threat 5
Chlamydial , need systemic treatment always
Herpes simplex after 2-3 weeks



Which of the following statements about
pterygium is true
It is a malignant transformation of bulbar
conjunctiva in response to environmental irritants
b) It is prevalent in white collar workers who use
computers extensively
c) It is most commonly found on the temporal side of
the bulbar conjunctiva
d) In an early stage into maybe managed with use of
artificial tears and topical vasoconstrictors
a)
Which of the following statements about
pterygium is true
It is a malignant transformation of bulbar
conjunctiva in response to environmental irritants
b) It is prevalent in white collar workers who use
computers extensively
c) It is most commonly found on the temporal side of
the bulbar conjunctiva
d) In an early stage into maybe managed with use
of artificial tears and topical vasoconstrictors
a)
Patients with episcleritis
a)
b)
c)
d)
Usually complain of severe deep pain.
Are very likely to have a systemic connective
tissue disease
Have engorged superficial vessels overlying
the sclera below the conjunctiva.
Can develop necrosis and melting of the
sclera with perforation.
Patients with episcleritis
a)
b)
c)
d)
Usually complain of severe deep pain.
Are very likely to have a systemic connective
tissue disease
Have engorged superficial vessels
overlying the sclera below the
conjunctiva.
Can develop necrosis and melting of the
sclera with perforation.


To differentiate, Place a drop of
Phenyephrine 2.5% , re-examine after 10-15
min , episceleral vessel should blanch.
Scleritis, causses vision loss , sever pain ,
wakes patient up at night tiem, thining(blue
hue) and necrosis of sclera
Glaucoma
POAG
PACG
Common 95%
 Chronic
 Painless
 Moderate IOP
 Normal cornea , pupil
 No symptom






Rare 5%
Acute onset
Painful red eye
Extremely IOP
Haze cornea, middilated
pupil , N/V, halo around
light
Risk factor for open-angel glaucoma include
each of the following except
a)
b)
c)
d)
African racial heritage
gender
Age greater than 60 years
Positive family history for glaucoma
Risk factor for open-angel glaucoma include
each of the following except
a)
b)
c)
d)
African racial heritage
gender
Age greater than 60 years
Positive family history for glaucoma
Primary open angel glaucoma is defined by
each of the following except
a)
b)
c)
d)
Adult onset
Open and normal appearing anterior
chamber angels
The absence of secondary causes for
glaucoma
An IOP of 25 mm Hg
Primary open angel glaucoma is defined by
each of the following except
a)
b)
c)
d)
Adult onset
Open and normal appearing anterior
chamber angels
The absence of secondary causes for
glaucoma
An IOP of 25 mm Hg
Secondary a glaucoma is caused by each of
the following except
a)
b)
c)
d)
Myopia
Uveitis
Chronic steroid use
Trauma
Secondary a glaucoma is caused by each of
the following except
a)
b)
c)
d)
Myopia
Uveitis
Chronic steroid use
Trauma
Remember IOP is a risk factor not a definition
 Remember myopia is a risk factor not a cause
, (even a minor risk factor )

An optic nerve with glaucomatous damage
may have all of the following except
a)
b)
c)
d)
A disc hemorrhage
Marked pallor of the neuroretinal rim
Displacement of the retinal vessels to the
margin of the disc
Thinning of the neuroretinal rim
An optic nerve with glaucomatous damage
may have all of the following except
a)
b)
c)
d)
A disc hemorrhage
Marked pallor of the neuroretinal rim
Displacement of the retinal vessels to the
margin of the disc
Thinning of the neuroretinal rim
•beta-adrenergic agonist
•alpha-2 adrenergic antagonists
•cholinergic agonists
•carbonic anhydrase agonists
All of the following statements regarding topical
beta blockers are true except
a)
b)
c)
d)
Beta blockers can worsen congestive heart
failure
Betaxolol is relatively selective beta 1 blockers
Topical beta blockers increase the outflow of
the aqueous humor
The duration of action of beta blockers is 12 to
36 hours, thus patients are dosed once or twice
a day
•beta-adrenergic agonist
•alpha-2 adrenergic antagonists
•cholinergic agonists
•carbonic anhydrase agonists
All of the following statements regarding topical
beta blockers are true except
a)
b)
c)
d)
Beta blockers can worsen congestive heart
failure
Betaxolol is relatively selective beta 1 blockers
Topical beta blockers increase the outflow of
the aqueous humor
The duration of action of beta blockers is 12 to
36 hours, thus patients are dosed once or twice
a day
Latanoprost (xalatan) can cause any of the
following side effects except
a)
b)
c)
d)
Conjunctival hyperemia
Ptosis
Increased iris pigmentation
Lengthening of the eyelashes
Latanoprost (xalatan) can cause any of the
following side effects except
a)
b)
c)
d)
Conjunctival hyperemia
Ptosis
Increased iris pigmentation
Lengthening of the eyelashes
Topical parasympathomimetic




Decrease the production of aqueous humor
Can produce eye or brow pain from induced
ciliary muscle spasm
Such as echothiophate can allow quicker
extubation of patients paralyzed with
succinylcholine
Have no known effect on the gastrointestinal
system
Topical parasympathomimetic




Decrease the production of aqueous humor
Can produce eye or brow pain from
induced ciliary muscle spasm
Such as echothiophate can allow quicker
extubation of patients paralyzed with
succinylcholine
Have no known effect on the gastrointestinal
system



CRVO
Blood and thunder
Second most common
retinopathy after DM,


Risk factor
HTN, DM, glaucoma,
arteriosclerotic vascular disease,
hyperviscosity, (PV, OCP, sickle
cell, lymphoma, leukemia,
Teratment of underlying disease

RD , retinal detachment
 Rhegmatogeneous (most
common)
caused by tear or hole,
Treatment, scleral buckle,
rtinopexy

Tractional
In diabetic retinopathy, CRVO, sickle cell, ROP,
trauma

Exudative
posterior uveitis, central serous retinopathy
tumor



Retinal tear
Supratemporal retina , most common site for
horseshoe tears
Caused by PVD, trauma,
Posterior vitreous detachment may be
associated with which of the following?
a)
b)
c)
d)
Darkness in the central division
Retinal tear or detachments
Athersclerosis
Temporal arteritis
Posterior vitreous detachment may be
associated with which of the following?
a)
b)
c)
d)
Darkness in the central division
Retinal tear or detachments
Athersclerosis
Temporal arteritis





Posterior vitreous detachment
Normal aging of vitreous liquefaction
Floater , flasheh
Complication:
Tear, RD, more in high myopes

Refere to ophthalmologist, dilated exam ,
F/U
No specific teratment


Drusen sign of :




Leading cause of blindness, cause
metamorphopsia,
Risk factors
F, age, family hx, smoking, caucasian, blue
eye
Dry (non-exudative): medical. Monitor,
antioxidants
Wet (exudative): laser, PDT, intravitreous
injection of anti-VEGF
In diabetic retinopathy vision loss may be
caused by
a)
b)
c)
d)
macular edema
macular ischemia
vitreous hemorrhage
all of the above
In diabetic retinopathy vision loss may be
caused by
a)
b)
c)
d)
macular edema
macular ischemia
vitreous hemorrhage
all of the above
All of the following are signs of
nonproliferative diabetic retinopathy except
a)
b)
c)
d)
Microaneurysm
Hard exudates
Neovascularization of the disc
Intraretinal hemorrhages
All of the following are signs of
nonproliferative diabetic retinopathy except
a)
b)
c)
d)
Microaneurysm
Hard exudates
Neovascularization of the disc
Intraretinal hemorrhages
Patient with type 2 diabetes should be
evaluated by an ophthalmologist
a)
b)
c)
d)
Beginning five years after diagnoses
Every two years after diagnoses
At the time of diagnoses
Not before puberty
Patient with type 2 diabetes should be
evaluated by an ophthalmologist
a)
b)
c)
d)
Beginning five years after diagnoses
Every two years after diagnoses
At the time of diagnoses
Not before puberty
A diabetic patient with symptoms of floaters
needs to be examined by an ophthalmologist
because of
These are typical symptoms of macular edema
Probably has suffered a retinal detachment
Needs to be evaluated by an ophthalmologist
to rule out the presence of a retinal
detachment or vitreous hemorrhage
d) Does not need to be seen by an
ophthalmologist because symptoms are
usually short-lived
a)
b)
c)
A diabetic patient with symptoms of floaters
needs to be examined by an ophthalmologist
because of
These are typical symptoms of macular edema
Probably has suffered a retinal detachment
Needs to be evaluated by an
ophthalmologist to rule out the presence of a
retinal detachment or vitreous hemorrhage
d) Does not need to be seen by an
ophthalmologist because symptoms are
usually short-lived
a)
b)
c)

Dx? Triad?





Dx? Triad?
APO
Arteriolar narrowing
Perivascular bonyspicule
Optic disc pallor


Remembre that
3th nerve palsy:Exotropia and
hypotropia , ptosis,

6th: Esotropia

4th :hypertropia and head tilt


Remember that need imaging
if in young pt or associated with
neurological signs,






Amblyopia ,
Reductoin of best corrected visual acuity due
to cortical suppression of sensory input
Etiologies
Strabismus , Refractive, Deprivation
Treatment
Occlusion of the good eye
Ptosis
Miosis
Anhydrosis
Heterochromia

DDx







DDx
Retinoblastoma
Cataract
Retinal
coloboma
ROP
Toxocariasis
Retinal
detachment

Kawasaki disease
No to steroid
Yes Aspirin

conjunctivits

Conjunctivitis

Oral mucosal
rash
Manifestations
of systemic diseases
All of the following are false regarding ocular
malignancies except
a)
b)
c)
d)
The most common intraocular malignancy in
adult is a primary ocular melanoma.
The most come primary site of origin of cancer
metastatic to the eye in males is the colon.
The most common primary site or origin of
cancer metastatic to the eye in females is the
breast
Enucleation is the primary treatment for
solitary metastases to the eye.
All of the following are false regarding ocular
malignancies except
a)
b)
c)
d)
The most common intraocular malignancy in
adult is a primary ocular melanoma.
The most come primary site of origin of cancer
metastatic to the eye in males is the colon.
The most common primary site or origin of
cancer metastatic to the eye in females is the
breast
Enucleation is the primary treatment for
solitary metastases to the eye.
The most common site for metastasis to the
eye is the
a)
b)
c)
d)
Iris
Choroid
Retina
Optic nerve
The most common site for metastasis to the
eye is the
a)
b)
c)
d)
Iris
Choroid
Retina
Optic nerve



Metastasis , most common intraocular
malignancy in adult
Breast in F, lung in M ,
Neuroblastoma in children

Malignant melanoma , most common
primary intraocular tumor in adult

BCC of lid most common lid malignany
All of the following are true regarding
intracranial hypertension except
The most common ocular manifestation is
optic disc edema.
b) Visual deficits that occur during presentation
are usually sever.
c) The most common visual symptoms are
transient visual obscurations.
d) Idiopathic intracranial hypertension can be
associated with vitamin A or D toxicity,
tetracycline therapy, and steroid withdrawal.
a)
All of the following are true regarding
intracranial hypertension except
The most common ocular manifestation is
optic disc edema.
b) Visual deficits that occur during presentation
are usually sever.
c) The most common visual symptoms are
transient visual obscurations.
d) Idiopathic intracranial hypertension can be
associated with vitamin A or D toxicity,
tetracycline therapy, and steroid withdrawal.
a)




Papilledema , bilateral disc swelling
Nausea/Vomiting/Headache
Transient visual obscuration
Pulsatile tinnitus
Sjogren syndrome
a)
b)
c)
d)
Is a complex disorder involving the retina
and choroid.
Is associated with antibodies such as anti SS-A antibodies
Requires surgical excision as primary
treatment
Effects man five times more often than
woman
Sjogren syndrome
a)
b)
c)
d)
Is a complex disorder involving the retina
and choroid.
Is associated with antibodies such as anti SS-A antibodies
Requires surgical excision as primary
treatment
Effects man five times more often than
woman
In patients with connective tissue disorder, dry eye
Are the most common ocular manifestations.
Are usually associated with permanent visual
loss.
c) Can be appropriately treated initially topical
antibiotics solutions.
d) Occur most commonly during acute
inflammatory episodes.
a)
b)
In patients with connective tissue disorder, dry eye
Are the most common ocular manifestations.
Are usually associated with permanent visual
loss.
c) Can be appropriately treated initially topical
antibiotics solutions.
d) Occur most commonly during acute
inflammatory episodes.
 Keratoconjunctivitis sicca,
a)
b)
Visual symptoms in migraine
a)
b)
c)
d)
Are always accompanied by headache
Usually have a poor Visual prognosis.
Vary from scintillations to total bilateral loss
of vision.
Are always accompanied by photophobia.
Visual symptoms in migraine
a)
b)
c)
d)
Are always accompanied by headache
Usually have a poor Visual prognosis.
Vary from scintillations to total bilateral
loss of vision.
Are always accompanied by photophobia.
Optic disc swelling in the malignant
hypertension
a)
b)
c)
d)
Often occurs even in the presence of mild
hypertension.
Should be treated the high-dose steroids.
Indicates that the patient is at increased risk for
developing heart failure and hypertensive
encephalopathy.
Occurs only in the setting of renal failure.
Optic disc swelling in the malignant
hypertension
a)
b)
c)
d)
Often occurs even in the presence of mild
hypertension.
Should be treated the high-dose steroids.
Indicates that the patient is at increased risk
for developing heart failure and hypertensive
encephalopathy.
Occurs only in the setting of renal failure.
Retinopathy the most common ocular
manifestation of HTN.
Key features of chronic HTN: AV nicking, blot
hemorrhages, cotton wool spots,
microaneurysm
Thyroid eye disease
Occurs only when the patient has abnormal
serum thyroid hormone level.
b) Can result in severe visual loss from optic
nerve compression or corneal damage.
c) Should be treated surgically in its early
congestive phase.
d) Will always improve with maintenance of a
euthyroid state
a)
Thyroid eye disease
Occurs only when the patient has abnormal
serum thyroid hormone level.
b) Can result in severe visual loss from optic
nerve compression or corneal damage.
c) Should be treated surgically in its early
congestive phase.
d) Will always improve with maintenance of a
euthyroid state
a)








NO SPECS
No sign
Only sign lid retraction, lag
Soft tissue swelling periorbital edema
Proptosis
Extraocula muscle weakness (diplopia)
Corneal exposure
Sight loss
Manifestations
of systemic diseases
All of the following are false regarding ocular
malignancies except
a)
b)
c)
d)
The most common intraocular malignancy in
adult is a primary ocular melanoma.
The most come primary site of origin of cancer
metastatic to the eye in males is the colon.
The most common primary site or origin of
cancer metastatic to the eye in females is the
breast
Enucleation is the primary treatment for
solitary metastases to the eye.
All of the following are false regarding ocular
malignancies except
a)
b)
c)
d)
The most common intraocular malignancy in
adult is a primary ocular melanoma.
The most come primary site of origin of cancer
metastatic to the eye in males is the colon.
The most common primary site or origin of
cancer metastatic to the eye in females is the
breast
Enucleation is the primary treatment for
solitary metastases to the eye.
The most common site for metastasis to the
eye is the
a)
b)
c)
d)
Iris
Choroid
Retina
Optic nerve
The most common site for metastasis to the
eye is the
a)
b)
c)
d)
Iris
Choroid
Retina
Optic nerve



Metastasis , most common intraocular
malignancy in adult
Breast in F, lung in M ,
Neuroblastoma in children

Malignant melanoma , most common
primary intraocular tumor in adult

BCC of lid most common lid malignany
All of the following are true regarding
intracranial hypertension except
The most common ocular manifestation is
optic disc edema.
b) Visual deficits that occur during presentation
are usually sever.
c) The most common visual symptoms are
transient visual obscurations.
d) Idiopathic intracranial hypertension can be
associated with vitamin A or D toxicity,
tetracycline therapy, and steroid withdrawal.
a)
All of the following are true regarding
intracranial hypertension except
The most common ocular manifestation is
optic disc edema.
b) Visual deficits that occur during presentation
are usually sever.
c) The most common visual symptoms are
transient visual obscurations.
d) Idiopathic intracranial hypertension can be
associated with vitamin A or D toxicity,
tetracycline therapy, and steroid withdrawal.
a)




Papilledema , bilateral disc swelling
Nausea/Vomiting/Headache
Transient visual obscuration
Pulsatile tinnitus
Sjogren syndrome
a)
b)
c)
d)
Is a complex disorder involving the retina
and choroid.
Is associated with antibodies such as anti SS-A antibodies
Requires surgical excision as primary
treatment
Effects man five times more often than
woman
Sjogren syndrome
a)
b)
c)
d)
Is a complex disorder involving the retina
and choroid.
Is associated with antibodies such as anti SS-A antibodies
Requires surgical excision as primary
treatment
Effects man five times more often than
woman
In patients with connective tissue disorder, dry eye
Are the most common ocular manifestations.
Are usually associated with permanent visual
loss.
c) Can be appropriately treated initially topical
antibiotics solutions.
d) Occur most commonly during acute
inflammatory episodes.
a)
b)
In patients with connective tissue disorder, dry eye
Are the most common ocular manifestations.
Are usually associated with permanent visual
loss.
c) Can be appropriately treated initially topical
antibiotics solutions.
d) Occur most commonly during acute
inflammatory episodes.
 Keratoconjunctivitis sicca,
a)
b)
Visual symptoms in migraine
a)
b)
c)
d)
Are always accompanied by headache
Usually have a poor Visual prognosis.
Vary from scintillations to total bilateral loss
of vision.
Are always accompanied by photophobia.
Visual symptoms in migraine
a)
b)
c)
d)
Are always accompanied by headache
Usually have a poor Visual prognosis.
Vary from scintillations to total bilateral
loss of vision.
Are always accompanied by photophobia.
Optic disc swelling in the malignant
hypertension
a)
b)
c)
d)
Often occurs even in the presence of mild
hypertension.
Should be treated the high-dose steroids.
Indicates that the patient is at increased risk for
developing heart failure and hypertensive
encephalopathy.
Occurs only in the setting of renal failure.
Optic disc swelling in the malignant
hypertension
a)
b)
c)
d)
Often occurs even in the presence of mild
hypertension.
Should be treated the high-dose steroids.
Indicates that the patient is at increased risk
for developing heart failure and hypertensive
encephalopathy.
Occurs only in the setting of renal failure.
Retinopathy the most common ocular
manifestation of HTN.
Key features of chronic HTN: AV nicking, blot
hemorrhages, cotton wool spots,
microaneurysm
Thyroid eye disease
Occurs only when the patient has abnormal
serum thyroid hormone level.
b) Can result in severe visual loss from optic
nerve compression or corneal damage.
c) Should be treated surgically in its early
congestive phase.
d) Will always improve with maintenance of a
euthyroid state
a)
Thyroid eye disease
Occurs only when the patient has abnormal
serum thyroid hormone level.
b) Can result in severe visual loss from optic
nerve compression or corneal damage.
c) Should be treated surgically in its early
congestive phase.
d) Will always improve with maintenance of a
euthyroid state
a)








NO SPECS
No sign
Only sign lid retraction, lag
Soft tissue swelling periorbital edema
Proptosis
Extraocula muscle weakness (diplopia)
Corneal exposure
Sight loss
Cotton-wool Patches in AIDS patients
a)
b)
c)
d)
Indicate obstruction of the pre-capillary
arterioles with infarction of the superficial
retina
Occur only in patient with advanced disease
Represent active cytomegalovirus (CMV)
retinal infection.
Often result in profound vision loss
Cotton-wool Patches in AIDS patients
a)
b)
c)
d)
Indicate obstruction of the pre-capillary
arterioles with infarction of the superficial
retina
Occur only in patient with advanced disease
Represent active cytomegalovirus (CMV) retinal
infection.
Often result in profound vision loss




DDFx of CWS
Diabetic retinopathy
HTN retinopathy
HIV
All of the following statements about optic
neuritis are false except
a)
b)
c)
d)
It is painless.
It always spontaneously resolves.
It may be initial manifestation of multiple
sclerosis
It usually results in permanent visual loss
All of the following statements about optic
neuritis are false except
a)
b)
c)
d)
It is painless.
It always spontaneously resolves.
It may be initial manifestation of multiple
sclerosis
It usually results in permanent visual loss
* In MS diplopia can be 2º to internuclear ophthlmoplegia (INO)





Young female
Blurred vision , decreased color vision, 2º to
optic neuritis,
Diplopia 2º to internuclear ophthalmoplegia
RAPD, ptosis, uveitis, optic atrophy,
nystagmus, optic neuritis
In optic neuritis, treatment with oral steroid
will increase the risk of MS
[email protected]
Toronto notes