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98 Cards in this Set
- Front
- Back
What causes a cherry red macula?
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CRA occlusion
Tay Sach's disease (formation of residual bodies, which are lipofuscin accumulating in lysosomes) |
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What diseases involve mitochondrial DNA
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Kearns Sayre syndrome (myopathy due to mitochondrial DNA deletions with ragged red fibers)
Leber's hereditary optic neuropathy (optic nerve disease mitochondrial DNA mutations. Late teens early 20s, central VA loss) |
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What can cause nystagmus
(3 diseases) |
Albinism, aniridia, achromatopsia
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Ocular ischemic syndrome:
-age group and gender -cholesterol or heart or HTN or diab? -where are hemes in eye? -blockage of what artery? |
- 65 yo male
- high cholesterol - midperipheral hemes - carotid and/or ophthalmic artery |
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Tolosa-Hunt Syndrome:
What causes the diplopia? |
Carotid-cavernous fistula (communication between artery and vein)
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Histoplasmosis:
-infecting agent -triad |
-fungus
1) peripapillary atrophy 2) punched out peripheral lesions 3) maculopathy |
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Toxoplasmosis vs toxocariasis vs histoplasmosis
Cause? Where in retina? |
Toxoplasmosis: parasite, cat litter
Toxocariasis: ingestion of larvae from dog or cat Histo: fungus Toxo starts in retina & can spread to choroid; Histo starts in choroid & can spread to retina |
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Which tests are treponemal?
Nontreponemal? Which are used to test Tx efficacy? Which are positive for life? |
Treponemal: FTA-ABS, MHA-TP, HATTS
Non-treponemal: RPR, VDRL TTreponemal TTrue for life (all have T in them) Non-treponemal: measures Tx. |
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HTN:
What is in stage 3? Stage 4? |
3-heme, CWS, hard exudates (out of vessels)
4-ONH swelling |
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Alcoholism and the optic nerve
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Toxic optic neuropathy: bilateral temporal nerve pallor
-ONH goes straight from healthy to dead (primary optic atrophy). Secondary opt atrophy gets edematous first then dies |
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Corneal abrasion Ddx: ulcer, marginal keratitis
Staining & defects |
-K abrasion: stains but no SEI
-Ulcer: Epi defect & SEI -Staph Marginal Keratitis: SEI with no epi defect |
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Commotio Retinae
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White patches in retina with history of recent trauma (photoreceptor outersegment disruption). Usually asymptomatic but if in macula results in acute vision loss and is called Berlin's edema
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Hyphema strong associations:
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Trauma, sickle cell, clotting disease, NSAIDS, Vossius ring (pigment ring on lens from pupil), Angle recession (60%).
-Elevate head at 30 deg |
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8-ball hyphema
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Black, fills entire ant chamber. B-scan, if idiopathic test blood (PT/PTT) Prothrombin, partial thromboplastin, sicklecell if AA or mediteranian. Always inquire about NSAID/aspirin
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Orbital floor fracture
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-Crepitus (crackle/pop when blowing nose)
-Entrapped inferior rectus (limit upgaze) -Damage to infraorbital nerve (touch cheeks and compare) -Don't blow nose for 48 hrs (infection) |
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Common causes of preseptal cellulitis
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Hordeolum (#1), dacrocystitis, skin trauma(insect bite)
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Orbital cellulits
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-Common cause of exophthalmos in kids
-Hx of fever, *sinus(ethmoid)/dental infection, trauma -Staph (adults), influenza(flu) (kids) -Diabetics/Immunocompromised can develop mucormycosis(fungus) leads to black eschar (mouth, nose) |
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Ddx orbital from preceptal
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Preceptal:no fever, proptosis, EOM restriction, increased pain with eye-movement
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Normal exophthalmometry readings:
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Whites:12-22
Blacks:12-24 Asians:12-18 Assymetry <4mm |
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Thyroid eye disease (TED)
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"NO SPECS"
-Females -Kocher's sign (the stare) -Von Graefe's sign(lid lag during downgaze) -Corneal exposure (SPK,SLK) -Inferior rectus first, then medial -Inflammation at orbital apex>nerve damage |
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Carotid Cavernous Fistula
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-Abnormal communication between artery and vein.
-Increases cavernous sinus pressure, backing up veins and decreasing outflow from orbit>**Pulsatile proptosis, redness, chemosis, CN6 palsy, bruit |
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Cavernous Hemangioma
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**Most common benign orbital tumor in adults
-Unilateral proptosis (tumor post. to globe) |
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General symptoms of Orbital Tumors
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APD, progressive decrease in VA, progressive proptosis (unilaterl)
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Capillary Hemangioma
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**Most common benign orbital tumor in children (capillaries are small, kids are small)
-Usually diagnosed early because of strawberry cutaneus lesions -70% are gone by age 7 |
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Rhabdomyosarcoma
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"RhaBD-rapid bone descruction"
-**Most common primary malignant pediatric orbital tumor -Tumor of mesenchyme (bone) |
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Neuroblastoma
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**2nd most common overall malignant tumor in peds (after Rhabdo)
**Most common secondary pediatric tumor -Usually kid already has abdomen cancer -Lid ecchymosis (kid who was suspected of being abused) |
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Meningioma
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**Most common benign brain tumor
-Middle aged women -Slow vision loss, proptosis nerve swelling, APD, diplopia |
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Most common intracranial tumor to spread to orbit
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Sphenoid meningioma
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Primary orbital meningiomas classic triad:
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1-VA loss
2-optic atrophy 3-optociliary shunt vessels (connect choriod with retina) |
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Dermoid Cysts
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Normal tissue in abnormal location
(definition of choristoma) -GOLDENHAR's syndrome (ocular dermoid, skin tag, vertebral dysplasia) |
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optic nerve glioma
(juvenile pilocytic astrocytoma) |
-Age 2-6
*Most common intrinsic tumor of optic nerve -50% association with neurofibromatosis type 1 (lisch nodules, fibromas, cafe aulait spots) |
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Orbital pseudotumor
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-Similar to thyroid eye disease (20-50, unilateral, proptosis) but also has sudden pain and inflammation of periorbit (chemosis, lacrimal, hyperopic shift)
-Idiopathic inflammatory process -If bilateral, raise suspicion for systemic vasculitis (Wegeners granulomatosis, Polyarteritis nodosa) or lymphoma |
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Tolosa-Hunt Syndrome
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-Idiopathic inflamm dz (dx of exclusion; "Hunt" for a ddx)
-Inflammation of Cavernous sinus (CN 3,4,5i,5ii,6) resulting in possible paresis of these nerves |
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Ocular rosacea
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-Common, middle aged women of european ancestry
-Telangetasia, rhinophyma(huge nose) -**Triggers (food, sun, alcohol, spicy food) |
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Contact Dermatitis
Type 1,2,3,4? |
Type 4 delayed hypersensitivity reaction
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Ocular cicatricial pemphigoid
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-Autoimmune damage to mucous membranes
-Symblepharon (eyelid-eyeball) -Ankyloblepharon(eyelid-eyelid) -Can be drug induced (beta blocker timolo, pilo) |
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Dermatochalasis
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-Weakend orbital septum allows prolapse of fat
-Redundant upper eyelid skin |
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Chalazion
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-sterile inflammation of meibomian gland
-ask about acne rosacea, seborrheic dermatitis |
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Hordeolum
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Acute staph infection of meibomian glands (internal) or zeis/moll (external)
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Ectropion
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-out turning of lid
-mechanical (tumor) -cicatricial -paralytic (Bell's palsy) -congenital -involutional (age related) |
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Entropion
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-can cause keratitis to pannus
-can be caused by Tracoma -classically caused by lashes growing posteriorly or Distichiasis (second row of lashes from meib glands) |
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Floppy eyelid Syndrome
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**Obese men with sleep apnea
-Spontaneos upper lid eversion and pillow exposure |
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Benign Essential Blepharospasm
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*Bilateral
-spasms of orbicularis, procerus, corrugator -80% preceeded by episodes of incr blinking -often accompanied by DES -if also suffers lower face abnormalities>Meige's syndrome -Myokymia=UNIlateral twitching (not closure) or orbicularis oculi |
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Basal Cell Carcinoma
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-More common in males 2:1
-**Most common eyelid cancer (90%) -Most common: nodular form with small firm shiny pearl -"rodent ulcer" is late sign -Surface telangetasia -lower lid, UV exposure |
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Squamous cell carcinoma
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-2nd most common eyelid cancer (50x less)
-erythematous Plaque -Often derived from actinic keratosis -lower lid more common |
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Actinic Keratosis
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-Premalignant elevated pink scaly lesion on sun-exposed skin
-*MOST common pre-malignant skin lesion |
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Sebaceous Gland Carcinoma
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*Bad boy of lid
**Recurrent chalazion *unilateral bleph -madarosis, lymphadenopathy -Arises from meibomian glands |
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Malignant Melanoma
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Extremely rare but are most lethal primary skin cancer
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Keratocanthoma
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-Initially similar to BCC or SCC, then they grow quickly, then involute/resolve.
-Cutaneous horn |
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Common causes of nasolacrimal duct obstruction
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Involutional Stenosis (older people)
Membranous blockage of valve of Hasner (younger) |
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Dacryocystitis
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-occurs when duct is plugged,
-Always shows as swelling below medial canthal tendon -if above tendon could indicate tumor -If chronic, suspect cancer *don't irrigate/refer untill tx started |
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Canaliculitis
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-Unresponsive to AB tx
-Swollen ("pouting") puncta -Discharge with palpation *Most common cause Actinomyces Israeli bacteria |
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Dacroadenitis
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*S-shaped ptosis
-Most common is chronic (inflamm: *sarcoid, TB, graves) -Acute: bacteria, virus, fever -Rule out tumor with biopsy |
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Jones 1 test
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Fluorescein is instilled, after 5 min eye is examined for NaFl, if it's gone and patient has NaFl in throat/nose that equals (+)test. Positive for flow.
-If (-) perform Jones 2 |
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Jones 2 test
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-Irrigate, if saline comes back out same punctum= canalicular blockage
-If saline comes out other punctum=nasolacrimal blockage |
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PAM (primary acquired melanosis)
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-Elderly white pts
-Pre-malignant (30%) -Biopsy -Anywhere on conj, sketchy borders |
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Conjuctival nevus
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Benign, suspicious if on cornea, tarsal conj, or fornix
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Conjuctival Melanoma
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-Arise from PAM 75% or nevus 20%
-Primary indicator of malignancy is thickness |
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Conjuctival squamous Papilloma
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-Benign tumor from HPV human papilloma virus
-Often resolve on own |
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Conjuctival Intraepithelial Neoplasia (CIN)
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**Most common pre-cancerous lesion on globe (leads to SCC)
-95% at limbus -Gelatin mass with neo |
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Conjuctival Squamous Cell Carcinoma
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-Rare, slow moving malignant tumor
-Arises from CIN |
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Conjuctival Melanoma arises from what?
Squamous cell carcinoma from what? |
PAM>Melanoma
CIN>Conjuctival SCC |
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Simple Bacterial Conjuctivitis
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-Very acute onset (hour)
-Usu kids; rare in adults -Usually staph -Mucupurulent discharge -Eyes stuck together in morning |
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Gonococcal Conjuctivitis
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-Bact; hyperacute onset (minute)
-Purulent discharge, *pseudomembrane, *preauricular lymph nodes (usu only occurs w/viral) -N. gonorrhea can invade intact cornea -Urethral discharge in men, 50%asymptomatic in women |
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Adenoviral Conjuctivitis
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-Adults
-Nodes -One eye then other *Follicles -Divided into 3 subtypes |
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Classic adenovirus syndromes (3)
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1-Acute non-specific follicular conjunctivitis: most common
2-Epidemic Keratoconjunctivitis (EKC): adults, **SEI's 3-Pharyngoconjunctival fever (PCF): kids, "swimming pool cojunctivitis," triad-fever, pharyngitis, conjunctivitis |
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Molluscum Contagiosum
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-DNA pox virus
-If multiple, consider HIV -Dome-shaped waxy nodule |
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Allergic Conjuctivitis
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-Papillae, chemosis
-Itching (if itch, burn, sting=dry eye) -Type 1 allergic response |
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Papillae
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-Central vessel
-Eosinophils, mast cells, neutro, lymphocytes -Allergic, bacterial (pABillae) |
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Follicles
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-Avascular
-White/grey -Immature *Lymphocytes/macrophages *Chlamdia, toxic, viral |
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Vernal Keratoconjuctivitis (VKC)
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-Very rare
-8yo asthmatic male with huge freakin papillae on lid eversion, happens every spring -Intense itching -*Trantas dots(limbus), Cobblestone papillae, shield ulcer (cornea) |
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Atopic Keratoconjuctivitis (AKC)
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-Young adults(20-40) w/hx of atopic dermat
-Prominent eyelid/periorbital involvment -*Dennie's lines (extra fold on lower lid) -Papillae more common inferiorly (unlike VKC,GCP) |
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GPC giant papillary conjuctivitis
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-Contact lens use, suture, ocular prosthetic
-Itchy, *ropy, decrease CL tolerance -Upper tarsal (sup pannus, SLK) -CL: deposits(allergenic), material, sln tox (SPK, classic: follicular conjunctivitis) |
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Chlamydia
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-Bacteria, but can cause nodes (PAN)
-Chronic red eye -Heavy folliclulosis, inf fornix -Painful urination |
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Opthalmia neonatorum
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Acute conjuctivits in newborn, usually chlamydia
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Chlamydia Trachoma
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-Leading cause of preventable blindness worldwide
-Chronic follicular conjuctivitis -Spread by housefly -Arlt lines (white horizontal lines on superior tarsus) -Herbert's pits (limbal from resoltn of limbal follicles) -Leads to scarring & entropion/trichiasis |
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Look up & pull down lid=
Look down and pull up lid= (most frequently missed, easiest to dx) |
Chlamydia
SLK |
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SLK
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-Thickend red superior bulbar conj
-Symptoms worse than signs (like acanthomeba) -Think thyroid disease or CL wear |
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Phlyctenulosis
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-Lymphocytic nodule
-Delayed hypersensitivity rxn -Bleph(staph), TB, acne rosacea |
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Ligneous conjuctivitis
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-Plasminogen deficency (catalyzies breakdown of fibrin)
-Woody |
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Parinaud's oculoglandular syndrome (cat scratch fever)
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*Granulomatous
-Huge lymph nodes -Cat scratch, tularemia (rabbit) |
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Pediculosis
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-Angry eyelids
-Lice, nits -Caused by Phthirus pubis |
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Pterygium
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-Destroys bowman's
-ATR astigmatism -Stocker's line (iron) |
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Episcleritis
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-Sectoral redness, usu unilateral, no pain
-Can be simple (80%) or nodular (20%) -Nodular can be moved slightly -* self limiting -Idiopathic 60% -Diseases (40%) RA, acne r., HZ |
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Scleritis
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-Females
-Diffuse & nodular more common than necrotizing -Necrotizing with inflammation deadly -Necrotizing without inflammation (Scleromalacia Perferans) is usu from chronic RA. -**Severe ocular pain**Bilateral -Granulomatous inflammation (RA, wegener's) |
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Anterior Uveitis
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-Pain, redness, photophobia
-Post synechiae, periph ant. synech, CME -Non-gran: above and maybe fine KP -Granulomatous has above with large KP (mutton fat, Koeppe/Busacca nodules) -70% are idiopathic -Decr IOP (CB stuck) |
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Acute non-granulomatous uveitis
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-"ARG BIL"
-Ankylosing spondylitis(lower back pain) -Reiter's syndrome (triad, **pee) -IBS (Crohn's,ucerative colitis) -Behcet's (asian, hypoyon, mouth ulcers) -*Lyme (tick bite, arthritis, *Bell's palsy) -Glaucomatocyclitic Crysis (mild iritis with recurrent iop spikes 30-40mm) |
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Chronic non-granulomatous uveitis
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-JRA: RF-,ANA+
-Fuch's Heterochromic iridocyclitis: cataract in young patient(30-40), mild cells, change in iris color, *no symptoms |
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Chronic Granulomatous Uveitis
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Sarcoid: AAF, ACE, chest xray
TB: PPD (15,10,5), chest xray Herpes: Syphilis: Maculopapular rash (hands&feet), Interstitial keratitis, VDRL, RPR, FTA-ABS |
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Drugs that induce uveitis
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Rifabutin (TB)
Sulfonamides Cidofovir (Antiviral for CMV) |
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Posterior Uveitis
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-Rashes, tick bites, AIDS, MS River valley
-Floaters, decreased vision -WBC in vitreous (snow globe) |
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6 diseases that cause post uveitis
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Toxoplasmosis
Histoplasmosis Sarcoidosis Syphilis Pars Planitis Cytomegaloviris |
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Toxoplasmosis
(post uveitis) |
-*Most common cause of uveitis in USA
-One big lesion, headlight in fog, cat poop -Parasite Toxoplasmas gondii |
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Histoplasmosis
(post uveitis) |
*triad*
1-Peripapilary atrophy 2-Punched out lesions 3-Maculopathy (often neo) -MS river valley or bird/bat droppings -Fungus -*chorioretinitis, no vitritis (toxo) |
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Sarcoidosis
(post uveitis) |
-Candle wax drippings (sheath vessels)
-Cotton ball opacities |
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Syphilis
(post uveitis) |
-Salt and pepper fundus
(Salt y Pepper) -Flame-shaped hemes -Great mimic |
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Pars Planitis
(post uveitis) |
Snow banking on inferior pars plana
|
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Cytomegaloviris
(post uveitis) |
-Immunocompromised
-White patches of necrotic retina, heme -Lots of blood, little cells (vs. toxo:lots of cells, PORN:minimal of both) |