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types of strabismus / causes of poor muscle tone
- congenital (present since birth): usually secondary to abnormal brain signal
- paralytic: damage (from stroke, trauma, etc.) to the nerves controlling the muscle
- restrictive: loss of muscle elasticity (due to scarring, inflammation, trauma, etc.)
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exo-
(strabismus with) outward deviation, resulting in light reflex apparent on nasal side of cornea
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eso-
(strabismus with) inward deviation, resulting in light reflex on temporal side of cornea
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-tropia
ocular deviation is continually manifest
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-phoria
misalignment is controlled by the brain and only manifest when one eye is covered
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strabismus vs. amblyopia
- strabismus: eyes out of alignment due to muscle imbalance
- amblyopia: uncorrectable decreased vision as a result of visual deprivation in early childhood (suppression secondary to strabismus)
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sign vs. symptom
- symptom: effects the pt. experiences; e.g. diplopia
- sign: abnormalities quantifiable on exam; e.g. strabismus
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eyeball protruding due to increased orbital pressure (2 terms)
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stye vs. chalazion
- chalazion: internal hordeolum caused by blockage of the meibomian gland
- stye: external hordeolum caused by bacterial infection of gland around eyelash follicle
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ptosis vs. blepharochalasis
- ptosis = droop of upper eyelid due to muscle or nerve damage
- blepharochalasis = folds of skin above the upper lid due to repeated eyelid edema that thins and loosens the skin
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legophthalmos
globe is not completely covered when eye is closed
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dacryocystitis
inflammation of lacrimal sac, usually caused by blockage of lacrimal duct
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conjunctivitis signs: viral vs. bacterial
- bacterial: thick fluid (mucus & pus "mucopurulent")
- viral: watery discharge; palpebral conjunctiva appears to have tiny bumps on it. Photophobia indicates corneal involvement.
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ophthalmia neonatorum
conjunctivitis in infants (<30 days old) due to bacteria or viruses present in the birth canal
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pinguecula vs. conjunctival nevus
- pingueculae: small yellow-white masses (degenerated bulbar conjunctival tissue) on the sclera
- nevi: yellowish-pink or brown tumors on bulbar conjunctiva
- both are usually benign; pingueculae may cause minor irritation
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keratitis
inflammation of the cornea
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hypopyon
accumulation of pus in the anterior chamber and redness of the bulbar conjunctiva secondary to corneal infection/ulcer
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arcus sinilis
opacity of outer edge of cornea; degenerative; does not affect vision
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hyphema
accumulation of blood in the anterior chamber, usually due to trauma but can also be caused by "certain diseases" (thanks a lot for the clarity, textbook)
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4 types & etiology of glaucoma
- primary/chronic open-angle (POAG): aqueous humor fails to drain through trabecular meshwork
- primary/acute angle-closure (NAG): increase of lens size as pt ages blocks aqueous humor from flowing out through pupil, then pushes iris forward until it blocks the outflow from anterior chamber angle
- secondary: drainage reduced due to other disease processes (inflammation, PDR, trauma, etc.)
- congenital: malformation of anterior chamber angle from birth
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symptoms of angle-closure glaucoma
- severe pain
- redness
- halos around lights (rainbow-colored)
- headache
- nausea/vomiting (sometimes)
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iritis symptoms
- pain
- photophobia
- blurred vision
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rubeosis iridis: definition & symptoms
- neovascularization (growth of new blood vessels) on iris
- may lead to reddish iris coloring
- can cause secondary angle-closure glaucoma
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anisocoria
unequal pupils due to muscular dysfunction (in turn usually due to nerve damage)
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endophthalmitis
bacterial infection of the vitreous (and possibly surrounding tissue)
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3 mechanisms of retinal detachment
- rhegmatogenous: liquid vitreous goes through a retinal tear/hole to the subretinal space
- exudative: fluid collects in subretinal space due to RPE abnormailty or defect of choroid or sclera
- tractional: fibrous growth (usually due to DM retinopathy) pulls on retina
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types/severity of diabetic retinopathy
- background (early): capillaries narrow, swell, and clog, and leak blood & exudate into the retina
- proliferative (advanced): the leaks cause new blood vessels & tissue to form (which pulls on the retina and can cause tractional detachment) and may leak blood into the vitreous
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treatment options (5) for retinal detachment
- cryopexy: surgially freezing
- photocoagulation: "welding" by laser
- pneumatoretinopexy: injected gas bubble
- scleral buckle: block of silicone to indent the wall
- posterior vitrectomy: surgical removal of vitreous
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retinitis pigmentosa
hereditary retinal degeneration
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papilledema
compression of optic nerve due to intracranial pressure, leading to engorged blood vessels and optic disc swelling
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anterior ischemic optic neuropathy
untreatable occlusion of blood supply to optic nerve
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10 types of disease/injury process
- infectious
- inflammatory
- allergic
- ischemic
- metabolic
- congenital
- developmental
- degenerative
- neoplastic
- traumatic
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corneal ulcer causes, symptoms/signs & treatment
- bacterial or fungal or result of herpes simplex
- corneal epithelium becomes eroded
- cornea becomes opaque
- herpes - branch-shaped figure shows on cornea under fluorescent dye
- antibiotics (topical and/or systemic) for bacterial/fungal; antiviral (topical and/or oral) for herpes
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4 causes of cataract
- aging
- injury
- disease
- congenital
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5 categories of disease types
- inflammatory / autoimmune
- metabolic
- vascular / ischemic
- infectious
- malignant / neoplastic
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synechiae
scarring of the pupil
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thyroid ophthalmopathy: definition & ocular manifestation
- immune system attacks extraocular muscles' receptor cells
- swelling can lead to proptosis, which can lead to exposure keratopathy
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sarcoidosis: definition & ocular manifestation
- inflammation & granulomas throughout the body
- most commonly causes uveitis, iritis or vitritis, but can also affect choroidal and retinal vessels, optic nerve and/or lacrimal gland
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myasthenia gravis: definition & ocular manifestation
- neurotransmitter deficiency in skeletal muscles
- commonly causes ptosis and diplopia, and can also cause limited ocular movement
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rheumatoid arthritis: definition & ocular manifestation
- joint pain, inflammation, stiffness (unknown cause)
- common ocular manifestations are uveitis, scleritis, corneal ulcers, and episcleritis
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lupus (systemic lupus erythematosus): definition & ocular manifestation
- autoimmune disorder, unknown cause
- causes retinal vasculitis & cotton-wool spots on retina; can also cause dry eye, scleritis and corneal ulcers
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multiple sclerosis: definition & ocular manifestation
- nervous system disease, affects white matter
- can casue optic neuritis
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signs of ischemic optic neuropathy
APD, suden loss, swelling of the ON head
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retinal artery occlusion vs retinal artery occlusion
- RAO: pale retina, cherry red spot.
- RVO: tortuous veins, hemorrhages
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Embolism associated vision loss
Retinal artery occlusion
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symptoms of ischemic optic neuropathy
Scalp tenderness, neck pain
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ischemic optic neuropathyis associa ed with what diseases
loss of vision due to reduced blood supply; associatedwith HTN, DM, temporal arteritis
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Kaposi sarcoma: definition & ocular manifestation
vascular growth of malignant cells on the lid & conunctiva; usually found in HIV+ pts
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cytomegalovirus: ocular manifestation
most commonly found in HIV+ pts, causes retinitis
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metastatic carcinoma: definition & ocular manifestation
cancerous tumors metastasizing from other body parts (usually breast or lung), most commonly into choroid
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cerebral neoplasm: definition & ocular manifestation
- brain tumor
- visual field defect & pupillary abnormality
- can also cause headaches and lead to papilledema
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signs of uveitis
sluggish pupil, circumlimbal flush, diminished red reflex, photophobia
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risk factors for uveitis
Psoriasis, IBD, TB, sarcoidosis
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signs of acute angle closure glaucoma
red eye, unresponsive pupil, corneal edema
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symptoms of angle closure glaucoma
headache, nausea, vomiting, halos, pain
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III nerve palsy
Can only gaze laterally. Vertical diplopia
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IV nerve palsy
vertical diplopia
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VI nerve palsy
Horizontal diplopia, esotropia
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causes of VI nerve palsy
Tumor, temporal arteritis, diabetes, aneurysm
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