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Opthalmic E for PAs
Emergency medicine
| Question | Answer |
|---|---|
| Accommodation | adapting/adjusting the eye to variations in distance consisting of pupillary constriction, convergence of the eyes and increased convexity of the lens |
| Refraction | the change in direction of a wave due to a change in its speed. This is most commonly observed when a wave passes from one medium to another. The deflection of light from a straight pathway thru the eye. |
| Amblyopia | otherwise known as lazy eye, is a disorder of the visual system that is characterized by poor or indistinct vision in an eye |
| Diploplia | double vision caused by extraocular muscles or a disorder of the nerves |
| Miosis | constriction of the pupil of the eye |
| Mydriasis | an excessive dilation of the pupil due to disease, trauma or the use of drugs |
| Photophobia | fear of light or sensitivity (found in headaces) |
| Presbyopia | farsighted: able to see distant objects clearly, comes on with old age |
| Scotoma | an isolated area of diminished vision, a shimmering film appearing as an island within the visual field |
| Xerophthalmia | abnormal dryness of the conjunctiva and cornea of the eyes; may be due to a systemic deficiency of vitamin A, associated with night blindness |
| Hyperopia | abnormal condition in which vision for distant objects is better than for near objects, usually present at birth |
| Hemianopsia | blindness in one half of the visual field of one or both eyes |
| Esotropia | crosseye, strabismus in which one or both eyes turn inward toward the nose |
| amaurosis fugax | Sudden and usually temporary vision loss caused by an "eye stroke." When a clot or blockage disrupts blood flow to the eye, symptoms can include curtain |
| What does a positive afferent pupillary defect represent? | optic nerve disorder |
| What is anisocoria? | unequal pupils |
| When should you test confrontation visual fields? | all optic complaints |
| What could restricted EOMs mean? | myositis, thyroid orbitopathy, mechanical entrapment of the muscles |
| What could interrupted or decreased innervations mean? | diabetes, HTN, tumors, aneurysm, infection, myasthenia gravis |
| What structures are found in the anterior segment? | conjunctiva, cornea, anterior chamber, lens, ciliary body |
| What can slit lamp examination reveal? | conjuctiva for hemorrhage, discharge inflammation, and FB; cornea for thickness; iris; lens; not the ciliary body |
| What is a modified seidel test? | uses a flourescein strip to paint the suspicious site, and then uses a cobalt blue filter on the slit lamp to examine the anesthetized eye, checking for leakage |
| When should you perform a dilated fundoscopic evaluation? | if intraocular FB, central retinal artery occlusion, or retinal detachement is suspected. |
| What is the normal IOP? | 10 to 21 mmHg |
| How can you measure IOP? | applanation tenometry (preferred), tonopen, schiotz tenometer |
| What is the usual offending pathogen in preseptal cellulitis? | Staph aureus |
| what is the most frequent source of postseptal cellulitis? | orbital extension of perinasal sinus infection |
| How can one differentiate pre and postseptal cellulitis clinically? | EOM impairment, proptosis, orbital and sinus CT scan |
| What are the most frequent sites of blowout fxs? | inferior wall of the maxillary sinus and medial wall of the ethmoid sinus |
| What conditions require immediate consultation with an ophthamologist? | CRAO, CRVO, suspected detached retina, giant cell arteritis |
| A cherry red spot is associated with what condition? | CRAO |
| A blood and thunder fundus is associated with what condition? | CRVO |
| What might flashing lights and floaters indicate? | Retinal detachment |
| What might cause painless ischemic optic neuropathy? | GCA |
| This dz presents as a painless ischemic optic neuropathy, is a systemic vasculitis, affects women more than men, has a past medical history of polymyalgia rheumatica, and may be accompanied | GCA |
| can cause rapid contralateral involvement if not diagnosed and treated promptly | GCA |
| acute staphylococcal infection of an oil gland associated with an eyelash. It is located at the lash line and has the appearance of a small pustule. | External Hordeolum/aka Stye |
| acute or chronic inflammation of the eyelid secondary to blockage of one of the meibomian oil glands in the tarsal plate. | Chalazion/ aka Internal Hordolum |
| Warm compresses and erythromycin ophthalmic ointment twice daily for 7 to 10 days. | external hordeolum/ stye |
| Warm compresses and erythromycin ophthalmic ointment qid 7 to 10 days, switch todoxycycline if chronic and recurrent. | chalazion/ internal hordeolum |
| Bacterial Conjunctivitis | mucopurulent discharge and inflammation of the conjunctiva. Often the eyelids are stuck together on awakening. Frequently there is a history of recent exposure to someone with "pink eye." |
| ddx includes corneal abrasion, ulcer, or dendrite | bacterial conjunctivitis |
| the tx for this disease is different for contact vs non-contact lens wearers | bacterial conjuctivitis |
| tends to follow an antecedent upper respiratory infection and often will have a palpable preauricular node, which aids in confirming the diagnosis. The discharge tends to be watery | Viral Conjunctivitis |
| DDx includes herpes dendrite and can be differentiated with a flouescein stain | viral conjuctivitis |
| ocular discharge, redness, and itching. Itching is a very common and consistent symptom seen with this condition | Allergic Conjunctivitis |
| neonatal conjuctivitis usually comes from this source | antimicrobial prophylaxis for gonococcal infection |
| how large can an eyelid laceration be and not be repaired? | <1 mm |
| What should be avoided when suturing an open wound of the eyebrow? | do not shave the hair |
| What should be done for corneal abrasions? | check for FB, optical sectioning for full thickness tearing and anterior chamber assessment, cycloplegia for pain control, treat, no patch for contact lens wearers |
| What should be done for corneal FB? | topical anesthetic, visual acuity, assess for full thickness injury, remove FB and rust if possible, do not burr in visual axis, evert the lid to check for more FB, tx corneal abrasion, refer to optho for next day appt |
| What chemical burn is usually worse, acid or alkali? | Alkali is worse because acid burs coagulate proteins and its penetration is limited |
| How do you tx chemical burns? | copious irrigation until pH is normal, check for epithelial defect. If no defect and normal anterior segment, then erythromycin ointment, cycloplegia, and eye patch. |
| Foggy vision, halo, hazy cornea, mid-dilated pupil are indication of what? | acute narrow angle glaucoma |
| How do you tx narrow angle glaucoma? | suppress aqueous humor production with bblockers, aadrenergic agonists, IV carbonic anhydrase inhibitors, surgical is peripheral laser iridectomy |
| white blood cells in the anterior chamber Can be viewed using a shortened slit beam (1 mm), room lights turned off, use high magnification setting, 45-60 degree angle created between incident light source and objective, and focus on the aqueous humor | Hypopyon |
| the presence of RBCs in the anterior chamber | hyphema |
| How does one treat hyphema? | elevate head, dilate pupil, control intraocular pressure, consult ophthalmology asap |
| What should one do if he suspects a ruptured globe? | Cover with metal eye shield and call ophthalmology asap. |
| What should be checked for blunt trauma of the eye? | slit lamp exam for integrity, check eye motility and visual acuity, dilate for fundoscopy |
| What is papilledema? | bilateral edema of the head of the optic nerve due to increased intracranial pressure (ICP) |
| What might papilledema indicate? | malignant hypertension, pseudotumor cerebri, intracranial tumors, and hydrocephalus |
| What is the common hx for retinal detachment? | painless decrease in vision, maybe light flashes or sparks, may be described as curtain in front of eye or as cloudy or smoky. |
| How does the physical exam of a detached retina appear? | gray with white folds and globular bullae |
Created by:
cwyatt13
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