Ophthalmology Board Review 2014

1. Amy Begnoche DO

2. Anatomy

3. Hoarders

4. Hordeolum (Sty)
Acute painful nodule
external lid
Zeis gland
Abcess of eyelid
Usually S. aureus
Tx: warm compress,
abx ointment, I&D
refractory cases

5. Chalazion
Chronic stye
Chronic
internalgranulomato
us (sterile) rxnof
Meibomian glands
Tx: warm compress,
refer to Optho for
excision

6. Blepharitis
Inflammation of the
eyelid
Dandruff of the eyelid
Chronic staph or strep
Tx: gentle scrub with
baby shampoo,
topical abx

7. Conjunctivitis
Bacterial:
-pus drainage
-strep or staph
-pseudomonal (contact
lens, treat with
aminoglyc/quinolone)
Tx: topical abx
ghonorrhea: 1st 3 days of
life, ocular emergency,
pouring pus out of the
eye, systemic abx
(rocephin, topical
erythromycin, cover for
chlamydia)
Chlamydia: first 5-14
days of life, systemic and
topical abx
Contagious for 2 weeks

8. Viral Conjunctivitis
adenovirus
Tx: cool compress, no school
Consider allergic or chemical

9. Corneal Abrasion
Minor trauma
Painful
Tx: abx ointment,
pain meds
***metal on metal
suspect intraocular
FB

10. Corneal Ulcer
Focal white opacity
Pain, redness, photop
hobia, visual defect
Caused by
bacteria, fungal, HSV
Urgent Ophtho referral
No patch (corneal
melting from
pseudomonas)

11. Dacrocystitis
Clogged
lacrimalduct
tears don’t drain
Purulent discharge
s. aureus
Tx: warm compress,
abx (augmentin)

12. Foreign Body
Remove with
moistened cotton
swab, needle
Evert eyelids, stain
with flourescein
Rust ring: needs to
be removed, burr
device, refer ophtho

13. Keratitis
Inflammation of
the cornea
Punctate: UV
exposure
(welder, snow
blindness)
Supportive
care, artificial
tears, topical abx

14. Herpes
Simplex
Keratitis causing foreign body
sensation
Dendritic corneal lesion
Tx: urgent ophtho consult, topical/po
antiviral, no topical steroids
Zoster
Ophthalmic branch of the trigeminal N.
(V1)
Hutchinson sign
Tx: systemic/topical antiviral, emergent
ophtho consult, +/- steroids, pain
control

15. Preseptalv. Orbital Cellulitis
Orbital
Sick, pain with eye
movement, proptosis
Tx: CBC, Bldcx, CT
obrits, IV abx
Preseptal/Periorbital
Pain, swollen lid
Complications:
meningitis, sepsis,
abscess, cavernous
sinus thrombosis (CN 3,
4, 6)vision loss from high
IOP

16. Glaucoma
Increased intraocular
pressure
Problem with flow of
aqueous humor through
trabecular meshwork and
Canal of Schlemm
Leads to damage of optic
nerve

17. Chronic (Open angle
glaucoma)
Gradual peripheral vision loss
age >40,African American, family hx
Tx: topical/systemic meds to decrease
aqueous humor production and increase
flow

18. Acute angle glaucoma
Precipitated by dim light (dilated pupil)
“walking out of a movie theater”
Painful loss of vision, headache, nausea, halos
Eye injected, steamy cornea, elevated IOP 40-70
Tx: emergency ophtho referral, topical/systemic meds to
decrease aqueous humor production and increase
flow
IV carbonic anhydrase inhibitor, BB gtt, mannitol,
pilocarpinegtt

19. Iritis
Acute painful red eye,
blurry vision
Can be traumatic
Ciliary flush – reddening
of sclera at the limbus
Cells and flare
No relief with topical
anesthetic
Tx: topical cycloplegic

20. Hypopyon
Pus in the anterior chamber of the eye
White cells layering out

21. Endophthalmitis
Infection of deep
eye structures
Pain + vision
impairment
Tx: intraocullar and
systemic abx

22. Optic Neuritis
Acute painful (central)
vision loss
Pain with eye movement
Inflammation of optic
nerve
“Marcus gun pupil” (APD)
Associated with MS
Can be caused by toxins,
meds, autoimmune dz
Tx: IV steroids

23. Retinal Detachment
Traumatic or atraumatic
Retinal tear allows vitreous
fluid to separate retina from
choroid
Risk factors:
old, degenerative
myopia, previous
detachment
Painless flashes of
light, floaters, curtain over
eye

24. Central Retinal Artery Occlusion
Ocular emergency
Sudden painless unilateral
vision loss
Emboli, thrombotic plaque,
vascultitis
Cherry red spot (perifoveal
atrophy), box cars (arteriolar
narrowing)
Tx: emergency ophtho referral,
poor prognosis, atherosclerotic
wkup

25. Central Retinal Vein
Occlusion
Thrombosis
Sudden, painless,
unilateral vision loss
“blood and thunder
retina”
Tx: thrombosis wkup

26. Eye Trauma

27. Burns
Alkali:
liqueficationnecrosis
(worse)
Acidic: coagulation
necrosis
Irrigate the eye until pH is
normal (7.4)

28. Globe Rupture
Scleral rupture from high IOP
Teardrop pupil, seidel’s sign
NO TONOPEN
Tx: hard shield, analgesia, tetanus, IV abx, ophtho consult

29. Hyphema
Blood in the anterior chamber
Can lead to increased IOP,
eye staining
Trauma, anticoagulation,
spontaneous (sickle cell)
Secondary bleeding as clot
retracts
Increased risk of glaucoma,
adhesions, vision loss
Tx: bedrest, analgesics, no
anticoag, ophtho consult

30. Orbital Fracture
Orbital walls made of thin bones
Weakest = floor
-infraorbital nerve involvement, inhibited upward
gaze, numbness of cheek or upper lip, diplopia
Tx: if nml exam, urgent ophtho referral

31. Retrobulbar Hematoma
hematoma causes
increased IOP

pressure on retinal A.

eye ischemia
(compartment syndrome)

Vision loss
Tx: lateral canthotomy,
meds to lower IOP

32. Lid Lacerations
Ophtho repair:
involve lid margin
6-8mm from medial canthus
involving lacrimal duct
involving inner surface of the lid
associated ptosis
<1mm heal spontaneously

33. References
Peer VIII
HippoEM
Intensive Review for Emergency Medicine
Qualifying Exam
Rivers Emergency Medicine Review