Term
| systemic diseases with important ophthalmic manifestations |
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Definition
acne rosacea
HIV
giant cell arteritis
Graves disease
MS
myasthenia gravis |
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Term
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Definition
dysfunction of the sebaceous glands of the face, neck, shoulders
evokes an immune response: patchy redness, papules, pustules, rhinohyma |
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Term
acne rosacea
ophthalmic manifestations |
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Definition
redness, blurring, foreign body sensation, pain
blepharitis, rarely keratitis |
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Term
HIV
ophthalmic manifestations |
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Definition
retinopathy: cotton-wool spots (infarction of nerve fibers layer), retinal hemorrhages --> reflect antigen-antibody plugs rather than infection
Kaposi's sarcoma can look like subjunctival hemorrhage
CMV retinitis most common O.I. |
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Term
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Definition
autoimmune disorder affecting medium sized branches of external carotid artery in the elderly
HA, scalp tenderness, jaw claudication, fever, anorexia, proximal muscle stiffness, malaise |
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Term
giant cell arteritis
ophthalmic manifestations |
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Definition
| arteritic ischemic optic neuropathy, central retinal artery occlusion, ocular motor cranial nerve palsy (or any CN 3, 4, 6) |
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Term
giant cell arteritis
diagnosis and management |
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Definition
lab: sed rate and CRP
temporal artery biopsy showing granulomatous inflammation
refer emergently for immediate corticosteroids |
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Term
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Definition
| autoimmune disorder cause abnormal thyroid metabolism and orbital soft tissue abnormalities |
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Term
Graves disease
ophthalmic manifestations |
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Definition
increased thy hormone --> sympathetic drive to increase eyelid muscle work
infiltration of tissues with lymphocytes --> into muscles, cause misalignment
red, watery eyes, eye prominence, double vision
lid retraction, conjunctival injection, tearing, proptosis, reduced eye movements, optic neuropathy
*Refer anyone with persistent redness, visual loss, eye prominence, or diplopia |
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Term
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Definition
artificial tears
immunosuppression
prisms
surgical realignment and decompression
thyroid regulation |
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Term
multiple sclerosis
ophthalmic manifestations |
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Definition
autoimmune disorder
optic neuritis, internuclear ophthalmoplegia, nystagmus, skew deviation, retinal venous sheathing, intermediate uveitis
urgent referral for MRI, IV steroids |
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Term
myasthenia gravis
ophthalmic manifestations |
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Definition
autoimmune disease affecting the NMJ, autoantibodies destroy ACh receptors on muscle cells
fluctuating ptosis, diplopia that worsens with prolonges activity
referral necessary
CT scan to rule out thymoma, yx poss with systemic antocholinesterase, immunosuppression, prisms in glasses |
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Term
| systemic medication with important ophthalmic manifestations |
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Definition
anticholinergics*
corticosteroids****
digoxin
ethambutol hydrochloride**
hydroxychloroquine sulfate**
isoniazid*
minoclycline**
sildenafil citrate
topiramate |
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Term
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Definition
loss of accommodation (in young)
pupil dilation
(rarely) angle closure glaucoma
it si OK to use on patients with open angle glaucoma
refer immediately for sudden onset pain or blurry vision
(GI/UTI, PD, psychotic, reactive airway disease) |
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Term
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Definition
cataracts very common
open angle glaucoma
intracranial HTN (in kids)
refer immediately for new onset HA, visual loss, pulsatile tinnitis; screen during first year of use
(immunosuppression, asthma, ...) |
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Term
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Definition
xanthopsia (reversible flickering, yellow-vision)
adjust does to therapeutic range
(cardiac) |
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Term
| *ethambutol hydrochloride* |
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Definition
can cause devastating optic neuropathy that is IRreversible
optic neuropathy (loss of color vision, acuity, fields) in doses greater than 15 mg/kg/day
important to get baseline ophthy screening and test acuity every 6 months - prompt referral with symptoms
(TB tx) |
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Term
| *hydroxychloroquine sulfate* |
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Definition
can cause irreversible pigmentary retinopathy in cumulative doses greater than 1000 grams or 6.5mg/kg(IDEAL)/day
baseline exam, yearly after 5 years or 1000 cum. gm
normal-->bulls-eye maculopathy
(immunosuppressive, RA, lupus) |
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Term
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Definition
irreversible optic neuritis (loss of color vision, acuity, fields)
baseline screening, test acuity every 6 months - immediate referral for worsening acuity
(TB tx) |
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Term
| *minocycline hydrochloride* |
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Definition
papilledema from intracranial HTN (blurred vision, field loss, pulsatile tinnitus, HA)
screen from papilledema every 2-3 months, refer promptly with new HA or visual impairment
(acne, antibiotic) |
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Term
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Definition
transient bluish vision, (ischemic optic neuropathy?)
refer immediately with sudden onset vision loss
advise pts with cardio RF and hx of ischemic optic neuropathy in other eye of possible risk
(viagra) |
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Term
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Definition
angle-closure glaucoma, myopic shift (bc of swelling of choroid, push eye structures forward)
refer immediately
(seizure and migraine) |
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Term
| ocular medications and systemic effects |
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Definition
alpha-2 adrenergic agonists
beta-adrenergic antagonists
oral and topical carbonic anhydrase inhibitors
prostoglandin analog
parasympathetics
sympathomimetics |
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Term
| alpha-2 adrenergic antagonists |
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Definition
treat glaucoma by reducing aqueous production and increasing aqueous outflow
dry mouth, lethargy, hypotension, seizures, do NOT use in kids - encephalopathy |
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Term
| beta-adrenergic antagonists (-olos) |
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Definition
treat glaucoma by decreasing aqueous production
bradycardia, bronchospasm (NO for asthmatics), reduced libido, depression |
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Term
| oral carbonic anhydrase inhibitors |
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Definition
treat glaucoma via decreased aqueous production
Stevens-Johnson syndrome, blood dycrasias, renal stones, tingling in hands/feet/mouth, nausea, abnormal taste sensation, loss of libio, transient potassium depletion
NOT a 1st line drug |
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Term
| topical carbonic anhydrase inhibitors |
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Definition
treat glaucoma via decreased aqueous production
bitter taste, no other significant effects
(doesn't work as well as oral) |
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Term
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Definition
treat glaucoma via increased aqueous outflow
rarely can cause flu-like sympotoms; can change color of iris
(Lumigan - eyelash growth) |
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Term
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Definition
dilation of pupil via block of muscarinic receptors of iris sphincter and ciliary muscles (inhibit accommodation)
fever, skin flush, tachycardia, confusion (primarily in children), very rarely seizures
(atropine, scopolamine) |
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Term
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Definition
pupil dilation via stimulation of iris dilator muscle
usually no SE at 2.5% does, 10% can cause BP increase, cardiac arrythmias, MI
(phenylephrine) |
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