Ophthalmology Review

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) Check vision
b) Check pupils for afferent pupillary defect
c) Irrigate eye with normal saline
d) 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) Check vision
b) Check pupils for afferent pupillary defect
c) Irrigate eye with normal saline
d) 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) Shield the eye

b) Patch the eye
c) Give topical or systemic antibiotics
d) Assess the vision
If a ruptured globe is suspected, the first
action to take is to:
a) Shield the eye

b) Patch the eye
c) Give topical or systemic antibiotics
d) 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) Orbital ultrasound
b) MRI scan of the orbits
c) CT scan of the orbits
d) Plain film of the skull
The best study to evaluate a patient with
intraocular foreign body is,
a) Orbital ultrasound
b) MRI scan of the orbits
c) CT scan of the orbits
d) Plain film of the skull
Management of orbital floor fracture
a) 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
Management of orbital floor fracture
a) 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
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
a) 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
In the case of the contact lens
wearer with this cornea
a) 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
 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) Topical corticosteroids
b) A tight patch over the eye for 48 to 72 hours
c) Topical anesthetic for less then 12 hours
only
d) Oral analgesic if necessary
Proper treatment for a corneal abrasion
includes which of the following?
a) Topical corticosteroids
b) A tight patch over the eye for 48 to 72 hours
c) Topical anesthetic for less then 12 hours
only
d) Oral analgesic if necessary
Conjunctival injection with discharge
a) Should be treated with a topical antibiotic even

if discharge is watery.
b) Can be treated with a topical steroid initially if
inflammation is significant.
c) Should be treated with parenteral antibiotic if
gonococcal.
d) Is probably of viral origin in the presence of
prominent itching symptoms
Conjunctival injection with discharge
a) Should be treated with a topical antibiotic even

if discharge is watery.
b) Can be treated with a topical steroid initially if
inflammation is significant.
c) Should be treated with parenteral antibiotic
if gonococcal.
d) 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) High IOP
b) Mild eye pain
c) Decreased vision
d) A fixed and dilated pupil
10. which of the following is not characteristic
of acute angel closure glaucoma
a) High IOP
b) Mild eye pain
c) Decreased vision
d) 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) Profound skin erythema with swelling

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

extending above the eyebrow
b) Limited ocular motility
c) Fever
d) 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) Ophthalmologic consultation
b) Orbital CT scan
c) Blood culture
d) 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) Ophthalmologic consultation
b) Orbital CT scan
c) Blood culture
d) 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) Jaw claudication
b) diabetes mellitus
c) age over 65 years
d) Scalp or forehead tenderness
12. which of the following is least consistent
with the diagnoses of temporal arteritis?
a) Jaw claudication
b) diabetes mellitus
c) age over 65 years
d) Scalp or forehead tenderness
In a patient who presents with unilateral visual
loss with scalp tenderness
a) A temporal artery biopsy should be

performed before steroids are started.
b) An erythrocyte sedimentation rate(ESR)
should be obtained immediately.
c) Involvement off the second eye is rare.
d) Temporal arthritis is unlikely if the patient is
older than 65.
In a patient who presents with unilateral visual
loss with scalp tenderness
a) A temporal artery biopsy should be

performed before steroids are started.
b) An erythrocyte sedimentation rate(ESR)
should be obtained immediately.
c) Involvement off the second eye is rare.
d) Temporal arthritis is unlikely if the patient is
older than 65.
In giant cell arteritis all of the following are true
except
a) 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.
In giant cell arteritis all of the following are true
except
a) 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.
 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) Temporal arteritis
b) Retinal detachment
c) Glaucoma
d) Nonarteritic optic neuropathy
13. Possible causes for sudden Visual loss
include all of following except
a) Temporal arteritis
b) Retinal detachment
c) Glaucoma
d) Nonarteritic optic neuropathy
. The best method for evaluating a 50-year-old
patient for best-corrected vision without his
or her glasses is,
a) Near card
b) Distance chart with pinhole
c) Distance chart with both eye open
d) Magazine or newspaper
. The best method for evaluating a 50-year-old
patient for best-corrected vision without his
or her glasses is,
a) Near card
b) Distance chart with pinhole
c) Distance chart with both eye open
d) Magazine or newspaper
What mechanism of action do cycloplegic
use to relieve pain?
a) Topical anesthetic
b) Paralysis of pupillary dilation
c) Paralysis of ciliary spasm
d) Decrease production of inflammatory cells
in anterior chamber
What mechanism of action do cycloplegic
use to relieve pain?
a) Topical anesthetic
b) Paralysis of pupillary dilation
c) Paralysis of ciliary spasm
d) 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) Continues digital massage of the globe to

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

dislodge an embolus
b) Topical beta blockers
c) AC paracenthesis by an
ophthalmologist
a) 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) Fibrin or cholesterol from an ulcerated

carotid plaque.
b) A calcified heart valve
c) Fibrin -platelet emboli from mitral valve
prolapse
d) Fibrin- platelet emboli from the aorta
In the elderly the most come source of emboli
to ophthalmic or retinal arterioles is
a) Fibrin or cholesterol from an ulcerated

carotid plaque.
b) A calcified heart valve
c) Fibrin -platelet emboli from mitral valve
prolapse
d) Fibrin- platelet emboli from the aorta
All of the following statements
regarding this trauma case are
true except
a) It is the result of a tear in an iris vessel.

b) It can be associated with other ocular injuries.
c) It is treated with the antibiotics and routine
activities.
d) It should be referred to ophthalmologist.
All of the following statements
regarding this trauma case are
true except
a) It is the result of a tear in an iris vessel.

b) It can be associated with other ocular injuries
c) It is treated with the antibiotics and routine
activities.
d) 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) The tip of the nose is involved

b) The upper lid is involved
c) The lower lid is involved
d) Either lid margin is involved
Herpes zoster involving the ophthalmic
devision of cranial nerve V is more likely to
have ocular involvements if
a) The tip of the nose is involved

b) The upper lid is involved
c) The lower lid is involved
d) 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) Patch the eye and give assurance of

spontaneous resolution
b) Prescribed a topical corticosteroid
c) Prescribed a topical antibiotic
ointment
d) 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) Patch the eye and give assurance of

spontaneous resolution
b) Prescribed a topical corticosteroid
c) Prescribed a topical antibiotic
ointment
d) 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) Assessment of possible canalicular injury

b) Foreign body removal
c) Tetanus prophylaxis
d) All of the above
Lid laceration repair should include
a) Assessment of possible canalicular injury

b) Foreign body removal
c) Tetanus prophylaxis
d) All of the above
 Lid margin laceration
 Medial lid laceration with canalicular involvement
Sunconjunctival hemorrhages
a) Are usually a sign of underlying
hematologic or coagulation abnormalities,
even in the absence of retinal
hemorrhages that require extensive
Systemic workup.
b) Are sometimes associated with severe
pain and or loss of vision.
c) Require cessation of any NSAID or
Systemic anticoagulant for resolution.
d) Resolve spontaneously in 2-3 weeks.
Sunconjunctival hemorrhages
a) Are usually a sign of underlying
hematologic or coagulation abnormalities,
even in the absence of retinal
hemorrhages that require extensive
Systemic workup.
b) Are sometimes associated with severe
pain and or loss of vision.
c) Require cessation of any NSAID or
Systemic anticoagulant for resolution.
d) Resolve spontaneously in 2-3 weeks.
Prolonged use of topical ophthalmic
anesthetics can cause
a) Iritis
b) Corneal damage
c) Open-angle glaucoma
d) Reactivation of a latent herpes simplex virus
infection
Prolonged use of topical ophthalmic
anesthetics can cause
a) Iritis
b) Corneal damage
c) Open-angle glaucoma
d) 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) Requires incision and drainage

b) Requires topical antibiotics
c) Requires a short course of systemic
antibiotics
d) 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) Requires incision and drainage

b) Requires topical antibiotics
c) Requires a short course of systemic
antibiotics
d) Includes warm compresses and lid
hygiene for 2 weeks
Still a chalazion
Neonatal Chlamydial conjunctivitis
a) Has become rare the advent of silver nitrate

prophylaxis
b) Occurs only after 21 days of age
c) Maybe treated with topical erythromycin
alone
d) Requires two weeks of systemic
erythromycin for effective treatment
Neonatal Chlamydial conjunctivitis
a) Has become rare the advent of silver nitrate

prophylaxis
b) Occurs only after 21 days of age
c) Maybe treated with topical erythromycin
alone
d) 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
a) 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
Which of the following statements about
pterygium is true
a) 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
Patients with episcleritis
a) Usually complain of severe deep pain.

b) Are very likely to have a systemic connective
tissue disease
c) Have engorged superficial vessels overlying
the sclera below the conjunctiva.
d) Can develop necrosis and melting of the
sclera with perforation.
Patients with episcleritis
a) Usually complain of severe deep pain.

b) Are very likely to have a systemic connective
tissue disease
c) Have engorged superficial vessels
overlying the sclera below the
conjunctiva.
d) 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%  Rare 5%

 Chronic  Acute onset
 Painless  Painful red eye
 Moderate IOP  Extremely IOP
 Normal cornea , pupil  Haze cornea, middilated
 No symptom pupil , N/V, halo around
light
Risk factor for open-angel glaucoma include
each of the following except
a) African racial heritage

b) gender
c) Age greater than 60 years
d) Positive family history for glaucoma
Risk factor for open-angel glaucoma include
a) African racial heritage

b) gender
c) Age greater than 60 years
d) Positive family history for glaucoma
Primary open angel glaucoma is defined by
a) Adult onset
b) Open and normal appearing anterior
chamber angels
c) The absence of secondary causes for
glaucoma
d) An IOP of 25 mm Hg
Primary open angel glaucoma is defined by
a) Adult onset
b) Open and normal appearing anterior
chamber angels
c) The absence of secondary causes for
glaucoma
d) An IOP of 25 mm Hg
Secondary a glaucoma is caused by each of
the following except
a) Myopia
b) Uveitis
c) Chronic steroid use
d) Trauma
Secondary a glaucoma is caused by each of
the following except
a) Myopia
b) Uveitis
c) Chronic steroid use
d) 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) A disc hemorrhage
b) Marked pallor of the neuroretinal rim
c) Displacement of the retinal vessels to the
margin of the disc
d) Thinning of the neuroretinal rim
An optic nerve with glaucomatous damage
may have all of the following except
a) A disc hemorrhage
b) Marked pallor of the neuroretinal rim
c) Displacement of the retinal vessels to the
margin of the disc
d) 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) Beta blockers can worsen congestive heart
failure
b) Betaxolol is relatively selective beta 1 blockers
c) Topical beta blockers increase the outflow of
the aqueous humor
d) 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) Beta blockers can worsen congestive heart
failure
b) Betaxolol is relatively selective beta 1 blockers
c) Topical beta blockers increase the outflow of
the aqueous humor
d) 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) Conjunctival hyperemia
b) Ptosis
c) Increased iris pigmentation
d) Lengthening of the eyelashes
Latanoprost (xalatan) can cause any of the
following side effects except
a) Conjunctival hyperemia
b) Ptosis
c) Increased iris pigmentation
d) 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) Darkness in the central division

b) Retinal tear or detachments
c) Athersclerosis
d) Temporal arteritis
Posterior vitreous detachment may be
associated with which of the following?
a) Darkness in the central division

b) Retinal tear or detachments
c) Athersclerosis
d) 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) macular edema
b) macular ischemia
c) vitreous hemorrhage
d) all of the above
In diabetic retinopathy vision loss may be
caused by
a) macular edema
b) macular ischemia
c) vitreous hemorrhage
d) all of the above
All of the following are signs of
nonproliferative diabetic retinopathy except
a) Microaneurysm
b) Hard exudates
c) Neovascularization of the disc
d) Intraretinal hemorrhages
All of the following are signs of
nonproliferative diabetic retinopathy except
a) Microaneurysm
b) Hard exudates
c) Neovascularization of the disc
d) Intraretinal hemorrhages
Patient with type 2 diabetes should be
evaluated by an ophthalmologist
a) Beginning five years after diagnoses

b) Every two years after diagnoses
c) At the time of diagnoses
d) Not before puberty
Patient with type 2 diabetes should be
evaluated by an ophthalmologist
a) Beginning five years after diagnoses

b) Every two years after diagnoses
c) At the time of diagnoses
d) Not before puberty
A diabetic patient with symptoms of floaters
needs to be examined by an ophthalmologist
because of
a) These are typical symptoms of macular edema
b) Probably has suffered a retinal detachment
c) 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 diabetic patient with symptoms of floaters
needs to be examined by an ophthalmologist
because of
a) These are typical symptoms of macular edema
b) Probably has suffered a retinal detachment
c) 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
 Dx? Triad?
 Dx? Triad?
 APO
 Arteriolar narrowing
 Perivascular bony-
spicule
 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) The most common intraocular malignancy in
adult is a primary ocular melanoma.
b) The most come primary site of origin of cancer
metastatic to the eye in males is the colon.
c) The most common primary site or origin of
cancer metastatic to the eye in females is the
breast
d) Enucleation is the primary treatment for
solitary metastases to the eye.
malignancies except
breast
The most common site for metastasis to the
eye is the
a) Iris
b) Choroid
c) Retina
d) Optic nerve
eye is the
a) Iris
b) Choroid
c) Retina
d) 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
a) 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.
optic disc edema.
are usually sever.
 Papilledema , bilateral disc swelling
 Nausea/Vomiting/Headache
 Transient visual obscuration
 Pulsatile tinnitus
Sjogren syndrome
a) Is a complex disorder involving the retina

and choroid.
b) Is associated with antibodies such as anti -
SS-A antibodies
c) Requires surgical excision as primary
treatment
d) Effects man five times more often than
woman
Sjogren syndrome

and choroid.
SS-A antibodies
treatment
woman
In patients with connective tissue disorder, dry eye
a) Are the most common ocular manifestations.

b) Are usually associated with permanent visual
loss.
c) Can be appropriately treated initially topical
antibiotics solutions.
d) Occur most commonly during acute
inflammatory episodes.

loss.
 Keratoconjunctivitis sicca,
Visual symptoms in migraine
a) Are always accompanied by headache

b) Usually have a poor Visual prognosis.
c) Vary from scintillations to total bilateral loss
of vision.
d) Are always accompanied by photophobia.

c) Vary from scintillations to total bilateral
loss of vision.
Optic disc swelling in the malignant
hypertension
a) Often occurs even in the presence of mild

hypertension.
b) Should be treated the high-dose steroids.
c) Indicates that the patient is at increased risk for
developing heart failure and hypertensive
encephalopathy.
d) Occurs only in the setting of renal failure.
hypertension

hypertension.
c) Indicates that the patient is at increased risk
for developing heart failure and hypertensive
encephalopathy.
Retinopathy the most common ocular
manifestation of HTN.
Key features of chronic HTN: AV nicking, blot
hemorrhages, cotton wool spots,
microaneurysm
Thyroid eye disease
a) 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
Thyroid eye disease

congestive phase.
euthyroid state
 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
malignancies except
breast
malignancies except
breast
eye is the
a) Iris
b) Choroid
c) Retina
d) Optic nerve
eye is the
a) Iris
b) Choroid
c) Retina
d) 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

optic disc edema.
are usually sever.
optic disc edema.
are usually sever.
 Papilledema , bilateral disc swelling
 Nausea/Vomiting/Headache
 Transient visual obscuration
 Pulsatile tinnitus
Sjogren syndrome

and choroid.
SS-A antibodies
treatment
woman
Sjogren syndrome

and choroid.
SS-A antibodies
treatment
woman

loss.

loss.
 Keratoconjunctivitis sicca,

c) Vary from scintillations to total bilateral loss
of vision.

c) Vary from scintillations to total bilateral
loss of vision.
hypertension

hypertension.
c) Indicates that the patient is at increased risk for
developing heart failure and hypertensive
encephalopathy.
hypertension

hypertension.
c) Indicates that the patient is at increased risk
for developing heart failure and hypertensive
encephalopathy.
Retinopathy the most common ocular
manifestation of HTN.
Key features of chronic HTN: AV nicking, blot
hemorrhages, cotton wool spots,
microaneurysm
Thyroid eye disease

congestive phase.
euthyroid state
Thyroid eye disease

congestive phase.
euthyroid state
 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) Indicate obstruction of the pre-capillary

arterioles with infarction of the superficial
retina
b) Occur only in patient with advanced disease
c) Represent active cytomegalovirus (CMV)
retinal infection.
d) Often result in profound vision loss
Cotton-wool Patches in AIDS patients
a) Indicate obstruction of the pre-capillary

arterioles with infarction of the superficial
retina
b) Occur only in patient with advanced disease
c) Represent active cytomegalovirus (CMV) retinal
infection.
d) 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) It is painless.
b) It always spontaneously resolves.
c) It may be initial manifestation of multiple
sclerosis
d) It usually results in permanent visual loss
All of the following statements about optic
neuritis are false except
a) It is painless.
b) It always spontaneously resolves.
c) It may be initial manifestation of multiple
sclerosis
d) 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
mabtahi@toh.on.ca
Toronto notes

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Ophthalmology Review

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Trauma

And red eye

a) Shield the eye

a) Shield the eye

a) Is a surgical emergency that requires immediate

a) Is a surgical emergency that requires immediate

There might be a picture of a kid with white

a) Should be treated with a topical antibiotic even

a) Should be treated with a topical antibiotic even

What would be the next plan

a) Profound skin erythema with swelling

a) Profound skin erythema with swelling

a) A temporal artery biopsy should be

a) A temporal artery biopsy should be

a) Continues digital massage of the globe to

a) Continues digital massage of the globe to

a) Fibrin or cholesterol from an ulcerated

a) Fibrin or cholesterol from an ulcerated

a) It is the result of a tear in an iris vessel.

a) It is the result of a tear in an iris vessel.

a) The tip of the nose is involved

a) The tip of the nose is involved

a) Patch the eye and give assurance of

a) Patch the eye and give assurance of

a) Assessment of possible canalicular injury

a) Assessment of possible canalicular injury

a) Requires incision and drainage

a) Requires incision and drainage

a) Has become rare the advent of silver nitrate

a) Has become rare the advent of silver nitrate

 Toxic , 1 day, silver nitrate or erythromycin ,

a) It is a malignant transformation of bulbar

a) It is a malignant transformation of bulbar

a) Usually complain of severe deep pain.

a) Usually complain of severe deep pain.

 Common 95%  Rare 5%

a) African racial heritage

a) African racial heritage

All of the following statements regarding topical

All of the following statements regarding topical

 Decrease the production of aqueous humor

 Decrease the production of aqueous humor

a) Darkness in the central division

a) Darkness in the central division

 Refere to ophthalmologist, dilated exam ,

 Dry (non-exudative): medical. Monitor,

a) Beginning five years after diagnoses

a) Beginning five years after diagnoses

 Malignant melanoma , most common

 BCC of lid most common lid malignany

a) Is a complex disorder involving the retina

a) Is a complex disorder involving the retina

a) Are the most common ocular manifestations.

a) Are the most common ocular manifestations.

a) Are always accompanied by headache

a) Are always accompanied by headache

a) Often occurs even in the presence of mild

a) Often occurs even in the presence of mild

a) Occurs only when the patient has abnormal

a) Occurs only when the patient has abnormal

 Malignant melanoma , most common

 BCC of lid most common lid malignany

a) Is a complex disorder involving the retina

a) Is a complex disorder involving the retina