Ophthalmology Review for Year 4 Med Students - PowerPoint PPT Presentation

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Ophthalmology Review for Year 4 Med Students

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  1. Ophthalmology Review for Year 4 Med Students

  2. Chapter 1 Trauma And red eye

  3. When a patient arrives at the ER with a supposed alkali chemical burn to the eye, what is your first action, • Check vision • Check pupils for afferent pupillary defect • Irrigate eye with normal saline • Check PH of the conjunctival fornix

  4. When a patient arrives at the ER with a supposed alkali chemical burn to the eye, what is your first action, • Check vision • Check pupils for afferent pupillary defect • Irrigate eye with normal saline • Check PH of the conjunctival fornix

  5. Chemical burn : • Acid , coagulate proteins and inhibit further corneal penetration • Alkali worse prognosis • never try to neutralize

  6. If a ruptured globe is suspected, the first action to take is to: • Shield the eye • Patch the eye • Give topical or systemic antibiotics • Assess the vision

  7. If a ruptured globe is suspected, the first action to take is to: • Shield the eye • Patch the eye • Give topical or systemic antibiotics • Assess the vision

  8. R/o intraocular foreign body with orbital CT scan, specially in metal on metal hammering • NPO • IV antibiotic • Tetanus status

  9. Need to be referred, • Decreased vision • Shallow anterior chamber • Hyphema • Abnormal pupil • Ocular misalignment • Retinal damage

  10. The best study to evaluate a patient with intraocular foreign body is • Orbital ultrasound • MRI scan of the orbits • CT scan of the orbits • Plain film of the skull

  11. The best study to evaluate a patient with intraocular foreign body is, • Orbital ultrasound • MRI scan of the orbits • CT scan of the orbits • Plain film of the skull

  12. Management of orbital floor fracture • Is a surgical emergency that requires immediate repair • Includes surgical repair only for persistent diplopia add/or cosmetic issues. • Does not require ophthalmology consultation because associated ocular damage is rare • Always includes topical and systemic antibiotics

  13. Management of orbital floor fracture • Is a surgical emergency that requires immediate repair • Includes surgical repair only for persistent diplopia add/or cosmesic issues. • Does not require ophthalmology consultation because associated ocular damage is rare • Always includes topical and systemic antibiotics

  14. Ur 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

  15. In the case of the contact lens wearer with this cornea • Instills antibiotics, patch the eye, and reexamine in 24 hours • Antibiotic coverage for gram-positive organism is important. • refer to an ophthalmologist only if the case is complicated by a corneal infiltrate. • The risk of ulceration is significantly higher than in not –contact Lens wearer

  16. In the case of the contact lens wearer with this cornea • Instills antibiotics, patch the eye, and reexamine in 24 hours • Antibiotic coverage for gram-positive organism is important. • refer to an ophthalmologist only if the case is complicated by a corneal infiltrate. • The risk of ulceration is significantly higher than in not –contact Lens wearer

  17. No patch in contact lens induced abrasions , risk of pseudomonas ulcer • No patch for simple abrasion less than 10mm, • Never prescribe topical anesthetics,

  18. Proper treatment for a corneal abrasion includes which of the following? • 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

  19. Proper treatment for a corneal abrasion includes which of the following? • 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

  20. Conjunctival injection with discharge • 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

  21. Conjunctival injection with discharge • 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.

  22. Papillae • Allergic conjunctivitis • Bacterial conjunctivitis • Follicles • Viral conjunctivitis • Chlamydial conjunctivitis

  23. Remember: Gonococcal conjunctivitis should be treated with parenteral antibiotic. Why? Risk of corneal perforation

  24. 10. which of the following is not characteristic of acute angel closure glaucoma • High IOP • Mild eye pain • Decreased vision • A fixed and dilated pupil

  25. 10. which of the following is not characteristic of acute angel closure glaucoma • High IOP • Mild eye pain • Decreased vision • A fixed and dilated pupil

  26. Primary angle closure glaucoma, risk factors Hyperopia Age>70 Female Family history Asian, Inuit people Mature cataract Shallow anterior chamber Pupil dilation

  27. 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

  28. 11. The finding that best distinguishes orbital cellulites from preseptal cellulitis is, • Profound skin erythema with swelling extending above the eyebrow • Limited ocular motility • Fever • Pain around the eye

  29. 11. The finding that best distinguishes orbital cellulitis from preseptal cellulitis is, • Profound skin erythema with swelling extending above the eyebrow • Limited ocular motility • Fever • Pain around the eye

  30. Ocular motility • Vision • RAPD • Sinusitis can cause orbital cellulitis and trauma , skin abrasoin any skin lesion can cause preseptal.

  31. All of the following are part of the evaluation and management of orbital cellulitis except • Ophthalmologic consultation • Orbital CT scan • Blood culture • Outpatient administration of oral antibiotics in an immunocompetent patient

  32. All of the following are part of the evaluation and management of orbital cellulitis except • Ophthalmologic consultation • Orbital CT scan • Blood culture • Outpatient administration of oral antibiotics in an immunocompetent patient

  33. ? • Request stat ophthalmology and ENT consultations to rule out a life–threatening fungal infection (mucoromycosis) • Diabetic patient with ketoacidosi, • Frozen globe, + RAPD

  34. Mucoromycosis • Request stat ophthalmology and ENT consultations to rule out a life–threatening fungal infection (mucoromycosis) • Diabetic patient with ketoacidosi, • Frozen globe, + RAPD

  35. 12. which of the following is least consistent with the diagnoses of temporal arteritis? • Jaw claudication • diabetes mellitus • age over 65 years • Scalp or forehead tenderness

  36. 12. which of the following is least consistent with the diagnoses of temporal arteritis? • Jaw claudication • diabetes mellitus • age over 65 years • Scalp or forehead tenderness

  37. In a patient who presents with unilateral visual loss with scalp tenderness • 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.

  38. In a patient who presents with unilateral visual loss with scalp tenderness • 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.

  39. In giant cell arteritis all of the following are true except • A low or normal sedimentation rate does not exclude the diagnoses • The most common cranial nerve paralysis that occur involves the third cranial nerve. • A deficit in choroidal circulation is typically seen on fluorescein angiography. • This condition typically affects people under age 60.

  40. In giant cell arteritis all of the following are true except • A low or normal sedimentation rate does not exclude the diagnoses • The most common cranial nerve paralysis that occur involves the third cranial nerve. • A deficit in choroidal circulation is typically seen on fluorescein angiography. • This condition typically affects people under age 60.

  41. Temporal arteritis or Giant cell arteritis • 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

  42. 13. Possible causes for sudden Visual loss include all of following except • Temporal arteritis • Retinal detachment • Glaucoma • Nonarteritic optic neuropathy

  43. 13. Possible causes for sudden Visual loss include all of following except • Temporal arteritis • Retinal detachment • Glaucoma • Nonarteritic optic neuropathy

  44. . The best method for evaluating a 50-year-old patient for best-corrected vision without his or her glasses is, • Near card • Distance chart with pinhole • Distance chart with both eye open • Magazine or newspaper

  45. . The best method for evaluating a 50-year-old patient for best-corrected vision without his or her glasses is, • Near card • Distance chart with pinhole • Distance chart with both eye open • Magazine or newspaper

  46. What mechanism of action do cycloplegic use to relieve pain? • Topical anesthetic • Paralysis of pupillary dilation • Paralysis of ciliary spasm • Decrease production of inflammatory cells in anterior chamber

  47. What mechanism of action do cycloplegic use to relieve pain? • Topical anesthetic • Paralysis of pupillary dilation • Paralysis of ciliary spasm • Decrease production of inflammatory cells in anterior chamber

  48. This patient presents with sudden unilateral vision loss. All of the following are treatment options except • Continues digital massage of the globe to dislodge an embolus • Topical beta blockers • AC paracenthesis by an ophthalmologist • Re-breathing CO2

  49. This patient presents with sudden unilateral vision loss. All of the following are treatment options except • Continues digital massage of the globe to dislodge an embolus • Topical beta blockers • AC paracenthesis by an ophthalmologist • Re-breathing CO2

  50. CRAO • Emboli from carotid a. • Emboli heart( arrhythmia, valvular, endocarditis) • Thrombosis • Temporal arteritis