Nr 602 Exam Questions & Answers
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Strabismus - ANSWERcrossed eyes; a defect in In ocular alignment, or the position of the eyes in
relation to each other; It is commonly called lazy eye. And strabismus, the visual axes are not parallel
because the muscles of the eyes are not coordinated; When one eye is directed straight ahead, the
other deviates
Retinoblastoma - ANSWERtumor arising from a developing retinal cell; intraocular tumor that
develops in the retina. Although it is rare, this malignant retinal tumor is the most common tumor in
childhood (some 4% of cancers in children younger than 15 years of age)
Retinoblastoma clinical findings - ANSWERstrabismus is the most common finding
there is a decreased visual acuity uni- or bilateral white pupil (leukocoria), described often as an
intermittent "glow, glint, gleam, or glare" by parents, is usually seen in low light settings or noted in
photographs taken with a flash i.e. (cat's eye reflex); other symptoms include an abnormal red reflex,
nystagmus, glaucoma, orbital Cellulitis and photophobia, hyphema, hypopyon (plus an anterior
Chamber of eye); Signs of global rupture or also possible
leukocoria - ANSWERcondition of white pupil
Bulbar or palpebral conjunctival infection - ANSWERa common presentation, which can be unilateral
or bilateral
conjunctival infection differential diagnosis - ANSWERallergy, conjunctivitis, infection, foreign body,
chemical exposure, or systemic inflammatory disease, irritation of the conjunctiva or cornea, and
congenital glaucoma.
conjunctival infection drainage - ANSWERwatery discharge; purulent/mucoid discharge
watery discharge - ANSWERcan occur with allergies, nasolacrimal obstruction, foreign bodies, viral
infection, and iritis.
Purulent or mucoid discharge - ANSWERnoted with chronic dacrocystitis or nasolacrimal obstruction.
Dacrocystitis - ANSWERinflammation of the tear sac
Advanced allergic conjunctivitis - ANSWERhave some mucoid production.
To differentiate, microscopic investigation of discharge may lead to other clues
photophobia - ANSWERsensitivity to light; symptom common of trauma and in infants with glaucoma
or retinal disease. Other non-eye related causes of this include migraines and meningitis.
leukocoria - ANSWERserious finding and demands immediate referral to the pediatric
ophthalmologist. white pupil
causes of leukocoria - ANSWERretinal detachment, cataract, retinal dysplasia, retinopathy of
prematurity, and in newborns retinoblastoma All newborns should have a fundoscopic examination
within 24 hours of birth and yearly on physical examinations.
,ophthalmia neonatorum - ANSWERconjunctivitis of the newborn. Etiology: chlamydia,
staphylococcus aureus, gonorrhea, HSV (silver nitrate reaction occurs on 10% of neontes). Clinical
findings: erythema, chemosis, purulent exudate with gonorrhea. Clear to mucoid exudate with
chlamydia. Diagnosis through gram stain to rule out gonorrhea and chlamydia.
ophthalmia neonatorum management - ANSWERsaline irrigation to the eyes until exudate is gone;
follow with erythromycin ointment. N. gonorrohea: ceftriaxone IM or IV. Chlamydia:
ceftriaxone IM or IV. Chlamydia: - ANSWERophthalmia neonatorum management x/t N. gonorrohea:
Erythromycin or possibly azithromycin PO - ANSWERophthalmia neonatorum management d/t
Chlamydia:
Antivirals IV or PO - ANSWEROphthalmia neonatorum management d/t HSV
Bacterial conjunctivitis - ANSWERpinkeye; very contagious
Bacterial conjunctivitis - ANSWERin neonates 5-14 days, preschoolers, sexually active teens:
Haemphilus influenza (Most common organism), streptococcus pneumoniae, S. Aureus, N.
gonorrohea. Erythema, chemosis, itching, burning, mucopurulent exudate, matter in the eyelashes -
worse in the morning, causing eyelashes to be shut; worse in winter; Dx through cultures (required in
neonates), r/o pharyngitis, AOM, URI, seborrhea
chemosis - ANSWERedema of the conjunctiva
Bacterial conjunctivitis neonate treatment - ANSWERErythromycin 0.5% ophthalmic ointment
Bacterial conjunctivitis >1 year treatment - ANSWERfourth generation fluoroquinolone. If concurrent
AOM: treat accordingly for AOM. Warm soaks to eyes TID; don't share towels or pillows; no school or
work until treatment begins
Chronic Bacterial Conjunctivitis - ANSWERLasts more than 3 weeks and unresponsive to treatment
Most common org is Staphylococcus Aureus. Gram negative orgs include:
-moraxella lacunata, serratia marcescens, ecoli, klebsiella pneumoniae, proteus.
Teens: Chlamydia
Erythema, chemosis, itching, burning, mucopurulwnt exudate, matter in the eyelashes; foreign body;
Dx by gram stain culture to r/o dacryostenosis, blepharitis, corneal ulcers, trachoma
Chronic Bacterial Conjunctivitis treatment - ANSWERdepends on prior treatment, lab results, and
differential diagnosis. Review compliance of previous drug choices; consult ophthalmologist
Inclusion conjunctivitis - ANSWERoccurs in neonates 5-14 days old and sexually active teenagers:
caused by : Chlamydia trachomatis; Erythema, chemosis, itching, burning, mucopurulnt exudate or
clear drainage, palpebral follicles. Cultures: ELISA, PCR r/o sexual activity
Inclusion conjunctivitis treatment - ANSWERNeonates: erythromycin or azithromycin PO;
Adolescents: doxycycline, azithromycin, EES, erythromycin base, levofloxacin PO
Viral conjunctivitis - ANSWERadenovirus MC; HSV-1 (dendritic ulcers); Erythema, chemosis, bilateral
tearing; HSV and herpes zoster: unilateral with photophobia, fever; Zoster: nose lesion. Cultures to
r/o corneal infiltration
,Viral conjunctivitis treatment - ANSWER• Lubricant drops
• Cool compresses TID-QID
• Antihistamines
refer to ophthalmologist if HSV or photophobia is present
Allergic or Vernal (springtime) conjunctivitis - ANSWERcauses tearing, itching, redness, & swelling.
treated with topical mast cell stabilizer/antihistamine drops. atopy sufferers; seasonal; stringy,
mucoid exudate, swollen eyelids and conjunctivae, itching, tearing, palpebral follicles, headache,
rhinitis; Eosinophils in conjunctival scrapings
Allergic or Vernal (springtime) conjunctivitis treatment - ANSWERnaphazoline/pheniramine,
naphazoline/antazoline ophthalmic solution. Mast cell stabilizer. Refer to allergist
chalazion - ANSWERa nodule or cyst, usually on the upper eyelid, caused by obstruction in a
sebaceous gland. Most commonly found above the eyelashes on the upper lid; a blocked oil gland
(meibomian or zeiss); firm painless lump; PAINLESS, NOT INVOLVING LASHES
Lid edema, or palpable mass
Red or grey mass on the inner aspect of lid margin; prevention: good hygiene.
treatment: warm compresses, surgery. antibiotic eyedrops if secondary infection (sulfacetamide or
erythromycin); follow up in 2-4 weeks, if still present after 6 weeks follow up with ophthalmologist
Chalazion - ANSWERBenign, chronic lipogranulomatous inflammation of the eyelid
Risk of Chalazion - ANSWERhordeolum or any condition which may impede flow through the
meibomian gland. Also mite species that reside in lash follicles
hordeolum (stye) - ANSWERstaph infection of a sebaceous gland in the eyelid. Most commonly found
at or near an eyelash follicle. Caused by bacterial infection either at the root of the eyelash follicle or
in the oil glands of the eyelid. Symptoms are tenderness and swelling; treatment: spontaneous
drainage and warm compresses
blepharitis - ANSWERinflammation of the eyelid; Inflammation/infection of the lid margins (chronic
problem); can have flaking skin, excessive tearing, redness, irritation, eyelash loss and/or crusty
debris along the lash line
Seborrheic Blepharitis - ANSWERMybomian gland dysfxn; posterior lid margin; greasy dandruff- no
skin ulcer; (non ulcerative) : irritants (smoke, make up, chemicals)
s&s - chronic inflammation of the eyelid, erythema, greasy scaling of anterior eyelid, loss of
eyelashes, seborrhea dermatitis of eyebrows and scalp
ulcerative blepharitis - ANSWER1) due to staph infection of follicles at the lid margin 2) accompanied
by loss of lashes, deformity of lashes (trichiasis); infection with staphylococcus or streptococcus
s&s - itching, tearing, recurrent styes, chalazia, photophobia, small ulceration at eyelid margin,
broken or absent eyelashes
the most frequent complaint is ongoing eye irritation and conjunctiva redness
, Blepharitis treatment - ANSWERTreatment-focused on lid hygiene - Careful daily cleansing of eyelids
to remove oils. This can be done with a Q-tip and baby shampoo. Couple times a day will be very
beneficial . Lid massage
Warm, moist compresses
Antibiotic : For infected eyelids - antistaphyloccocal antibiotics BACITRACIN, ERYTHROMYCIN 0.05%
for 1 week AND QUIONOLONE OINTMENTS; For infection resistant to topical - TETRACYCLINE 250 MG
PO X4 DOXYCYCLINE 100 MG PO X2
Avoid the use of contact lenses and use good hand hygeine
dacryocystitis - ANSWERinflammation of the tear (lacrimal) sac; infection can result.
Dacryocystitis Tx - ANSWER•systemic abx (cephalexin, erythromycin)
•warm wash cloth
•ophtho consult/referral
Gentle pressure applied in a downward and medial direction transmits hydrostatic force through the
nasolacrimal duct to the obstruction. This technique should be performed two or three times a day.
The eyelid should be cleaned with plain water after massage. Treatment of dacryocystitis is warm
compresses AND oral or parenteral antibiotics
Sodium sulfacetamide 10% ophthalmic solution or ointment - ANSWERUsed in treatment of bacterial
conjunctivitis. not effective against H. influenzae; stings; can cause allergic reactions (including
Stevens-Johnson syndrome)
Erythromycin 0.5% ophthalmic ointment - ANSWERUsed in treatment of bacterial conjunctivitis.
ointment for patients with sulfa allergy and infants
Fluoroquinolone ophthalmic drops - ANSWERincluding besifloxacin, ciprofloxacin, gatifloxacin,
levofloxacin, moxifloxacin, or ofloxacin for children older than 12 months
The aminoglycosides (neomycin, tobramycin, and gentamicin) are to be avoided because of possible
hypersensitization, severe allergic reactions, and increasing resistance.
H. influenza - ANSWER(Most common organism of bacterial conunctivitis)
Viral conjunctivitis - ANSWERmost commonly caused by adenovirus. coxsackie virus, herpes,
molluscum
S&S - profuse tearing, mucous discharge, burning, concurrent URI, enlarged or tender preauricular
nose
Antihistamines/decongestant
Improvement, self limiting, 7-14 days
gonococcal conjunctivitis - ANSWER2-4 days after birth, most concern can cause blidness
