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Questions and Answers
What is a primary concern when diagnosing acquired esotropia?
Which type of strabismus is characterized by an outward deviation of one eye?
What is the most common cause of vertical strabismus?
Which of the following is NOT a sign or symptom of strabismus?
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In the context of strabismus, which factor is considered a risk factor?
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Which condition is NOT an indication for immediate referral to an ophthalmologist for eye trauma?
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What is the most common cause of orbital cellulitis?
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Which of the following is a common symptom of orbital cellulitis?
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Which of these organisms is NOT commonly associated with orbital cellulitis infections?
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What is the recommended initial approach for diagnosing orbital cellulitis?
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Which demographic is MOST commonly affected by orbital cellulitis?
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Which type of injury does NOT fall under the immediate referral criteria for an ophthalmologist?
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What are some common signs and symptoms of advanced diabetic retinopathy?
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Which sign is NOT typically associated with orbital cellulitis?
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Which diagnostic evaluation methods can be used for diabetic retinopathy?
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Which treatment is primarily aimed at managing macular edema in diabetic retinopathy?
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What is the most important modifiable factor in the management of diabetic retinopathy?
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What is a characteristic finding in the fundoscopic examination of diabetic retinopathy?
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How often should patients with Type 2 diabetes have eye examinations?
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What is the underlying cause of hypertensive retinopathy?
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What is the recommended frequency of eye examinations for patients diagnosed with Type 1 diabetes?
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What condition is characterized by the inability to see close objects clearly?
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What is the common treatment method for astigmatism?
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Which of the following is a sign or symptom of hyperopia?
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What is the primary cause of presbyopia?
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In which population is presbyopia most commonly observed?
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Which condition involves blurred or distorted vision at any distance?
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What common sign could indicate the presence of astigmatism?
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What characterizes exotropia?
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Which of the following is NOT a recommended patient education practice for managing vision conditions?
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What is the primary risk factor for primary acute angle-closure glaucoma?
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Which cranial nerves are essential to examine for strabismus evaluation?
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Which of the following is a symptom of acute angle-closure glaucoma?
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Which treatment option is commonly recommended for managing strabismus?
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In what population is chronic primary open-angle glaucoma most commonly found?
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Which of the following is NOT included in the differential diagnosis of strabismus?
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What indicates the need for emergency treatment in glaucoma?
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Study Notes
Orbital Cellulitis
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Definition: Infection of soft tissues surrounding the eye, located posterior to the orbital septum.
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Pathophysiology: Infection spreads from sinuses (ethmoid sinus most common), dental, facial, globe, eyelid, and lacrimal infections.
- Direct inoculation via trauma or surgery.
- Spread from bacteremia.
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Etiology:
- Bacterial: Streptococcus pneumoniae (lower incidence with pneumococcal vaccine), Staphylococcus aureus, Haemophilus influenzae, Gram-negative bacteria.
- Fungal: Mucor and Aspergillus species.
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Common in children (M>F), adults (F>M with MRSA infections).
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Higher mortality in those with fungal infections and immunocompromised individuals.
Orbital Cellulitis Signs & Symptoms
- Fever, eyelid edema and redness.
- Ptosis (drooping eyelid), restricted extraocular movements (EOM).
- Orbital pain and tenderness.
- Exophthalmos (bulging eye), purulent discharge (pus), conjunctivitis.
- Visual decrease, sluggish pupillary response.
- Elevated intraocular pressure.
Diabetic Retinopathy
- Initially asymptomatic.
- Advanced stages: floaters, blurred vision, progressive vision loss.
- Fundoscopic Examination:
- Microaneurysms (tiny bulges in retinal blood vessels).
- Venous loops and beading.
- Dot and blot hemorrhages.
- Macular edema.
- Flame-shaped hemorrhages.
- Cotton-wool spots.
- Retinal exudates (leaky fluid).
Diabetic Retinopathy
- Differential diagnosis: Retinal vein occlusion, ocular ischemic syndrome, macular edema (diabetics).
Diabetic Retinopathy treatment
- Triamcinolone (corticosteroid).
- VEGF inhibitors (Afibercept, Ranibizumab) for macular edema and neovascularization management.
- Glycemic control (A1C 6-7%) is the most critical modifiable factor.
- Optimize blood pressure, kidney function, and serum lipids.
- Laser photocoagulation and vitrectomy.
Diabetic Retinopathy Prevention
- Eye exam at diabetes diagnosis, every 5 years for Type 1 diabetes, annually for Type 2 diabetes.
- Report visual symptoms immediately.
- Smoking cessation and management of hypertension, kidney disease, and hyperlipidemia.
Hypertensive Retinopathy
- Retinal changes due to hypertension that may affect vision.
- Commonly associated with chronic hypertension.
Strabismus (Eye Misalignment)
- Misalignment of eyes.
- Can cause decreased vision, frequent blinking/squinting, head tilting, diplopia, faulty depth perception.
Strabismus Types
- Esotropia: inward deviation of one eye.
- Exotropia: outward deviation of an eye.
- Vertical strabismus: hypertropia (eye deviates upwards) or hypotropia (eye deviates downwards).
- Acquired esotropia: accommodative, occurs when children try to accommodate hyperopia (farsightedness).
Strabismus Risk Factors
- Family history, refractive error, Down syndrome, cerebral palsy, stroke/head injury.
Strabismus Treatment
- Eyeglasses, contact lenses, prism lenses.
- Vision therapy.
- Surgery.
Glaucoma
- Increased pressure within the globe, causing optic nerve damage.
Glaucoma Types
- Primary Acute Angle-Closure Glaucoma: Ophthalmologic emergency caused by closure of a narrow anterior chamber angle, obstructing outflow of aqueous fluid.
- Secondary acute angle closure glaucoma: Does not require pre-existing narrow angle, may occur due to uveitis, dislocated lens, or certain medications.
- Chronic Angle-Closure Glaucoma: Obstructed flow of aqueous fluid into the anterior chamber angle.
- Chronic Primary Open-Angle Glaucoma: Elevated intraocular pressure due to reduced drainage of aqueous fluid through the trabecular meshwork.
Glaucoma Signs & Symptoms
- Acute angle-closure glaucoma:
- Rapid onset of red, painful eye with tearing, profound visual loss, halos around lights, fixed & mid-dilated pupil, diaphoresis (excessive sweating), nausea, abdominal pain.
- Cloudy cornea, firm globe on palpation.
- Intraocular pressure may exceed 50mm Hg (normal limits 10-20 mm Hg).
- Open-angle glaucoma (Chronic glaucoma):
- No symptoms in early stages. Later stages can include blurred vision, headaches, halos around lights, decreased peripheral vision.
Hyperopia (Farsightedness)
- Ability to see distant objects clearer than close objects.
- Eye does not bend light properly due to a shorter eyeball or insufficiently curved cornea.
- Visual images focus behind the retina.
- Risk factors: Inherited.
- Signs & Symptoms: Difficulty focusing on close objects, eyestrain, squinting, headaches.
Astigmatism
- Blurred or distorted vision at ANY distance.
- Irregularly shaped cornea or lens, causing uneven focus.
- Risk factors: Hereditary, eye injury, surgery, or disease.
- Signs & Symptoms: Blurred vision, difficulty with night vision, headaches, squinting.
Presbyopia
- Gradual loss of the ability to focus on near objects.
- Shape of the lens changes with age, becoming harder and less flexible to adjust focus for close objects.
- Risk factors: Aging adult (early-mid 40's), diabetes, CVD, multiple sclerosis, certain medications.
- Signs & Symptoms: Blurred near vision, eyestrain (reading material needs to be held further away), headaches.
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Description
Test your knowledge on orbital cellulitis, its definition, pathophysiology, etiology, and symptoms. This quiz covers the causes of infection and the populations most at risk. Perfect for medical students and healthcare professionals looking to reinforce their understanding.
