5 Must-Know Eye Conditions for the ABIM Board and NBME Shelf Exams

While most of the ABIM Examination topics fall neatly into organ system categories, not all of them fit into this schematic. These include: ophthalmology, primary care screening guidelines, vaccinations, etc. Here at Knowmedge, we’ve incorporated this important group of subject areas into General Internal Medicine, similar to the American College of Physicians’ Internal Medicine In-Training Exam Blueprint.

Today, in this first of a series of blogs, we review the key eye diseases: Conjunctivitis, Macular Degeneration, Glaucoma, Retinal Detachment, and Cataracts. The eyes may see only what the mind knows, but your mind should know these eye conditions for the ABIM exam. The exam is several months away so go ahead and bookmark this page so you can quickly review it once more in the days before you obtain your certification or recertification.

1. Conjunctivitis

Conjunctivitis is broken down into viral, bacterial, and allergic conjunctivitis

Viral

Usually caused by adenovirus
Having a preceding upper respiratory infection or recent exposure to a person with conjunctivitis are clues to aid in the diagnosis
Acute onset
Usually unilateral redness
Watery discharge is present
Highly contagious
Frequent hand washing must be performed to prevent spread of infection
Supportive treatment including cold compresses and artificial tears. NO role for antibiotic eye drops with viral conjunctivitis

Bacterial

Common causing agents are Staph aureus, Streptococcus pneumoniae, or Haemophilus influenzae. People who wear contact lenses can be infected by Pseudomonas aeruginosa
Presence of mucopurulent discharge and crusting can occur in the morning when the discharge is dry
Usually leads to redness of unilateral eye but may have bilateral involvement if spread occurs by rubbing both eye
Should be treated with antibiotics (e.g. erythromycin ointment and/or polymyxin-trimethoprim drops) for 5-7 days
Patients who wear contact lenses should not wear contact lenses for at least 7 days
If patient has bacterial conjunctivitis for 4 weeks, this is chronic in nature and should be evaluated by an ophthalmologist

Allergic

Can mimic viral conjunctivitis in terms of having clear (or ropy) discharge but predominant symptom is eye itching that corresponds to specific seasons
Treatment is with oral anti-histamines, topical anti-histamines, and artificial tears

For another look at conjunctivitis, take a look at our previous post

2. Macular Degeneration

Common in elderly individuals
Can lead to visual loss
Progression of disease can lead to difficulty reading, driving, or performing activities of daily living
Two sub-types of macular degeneration are dry (atrophic) and wet (neo-vascular). Most cases are dry macular degeneration. If, however, patient has wet macular degeneration, it is more serious and can lead to blindness in an acute fashion rather than progressive fashion.
Biggest risk factors are age, family history, cardiovascular disease, and smoking
Quitting smoking reduces the risk of developing macular degeneration and some studies suggest that diet high in anti-oxidants can be protective. Patients can also benefit by using a magnifying glass.

3. Glaucoma

Condition is a condition resulting from increased intra-ocular pressure due to blockage in drainage of aqueous humor. It can be broken down into primary open angle glaucoma (POAG) and acute angle closure glaucoma.

POAG

Most common form of glaucoma and most common cause of irreversible blindness in the world
Painless loss of peripheral vision that is gradual in nature. Later on it can affect central vision
Optic cup: disc ratio >0.5
Risk factors include age greater than 40, being African-American race, and positive family history
Mainstay of treatment is with pharmacological eye agents such as beta blockers, carbonic anhydrase inhibitors, adrenergic agonists, hyperosmotic agents, and prostaglandin analogues

Acute Angle Closure Glaucoma

More severe than POAG
Red eye, severe pain, headache, nausea and vomiting and visual halos
Intra-ocular pressure can be as high as 50 mm Hg
When suspected, immediate referral to an ophthalmologist is required to prevent permanent optic nerve atrophy

4. Retinal Detachment

Patients may present with floaters, squiggly lines, flashes of light
This is an ophthalmology emergency and requires immediate attention by an ophthalmologist

5. Cataracts

Opacity of lens will occur
Symptoms include painless decreased visual acuity, decreased night vision, glare, and sometimes double vision
Physical examination can reveal a decreased or absent red reflex
Treatment is surgical removal of the cataract

For another look at cataracts, take a look at a previous post

Once again, the folks who write the Internal Medicine licensing exams don’t expect you to have the depth of knowledge regarding the plethora of eye diagnoses that an ophthalmologist possesses. However, topics such as the ones mentioned in the pearls above should assist you with the General Internal Medicine section of the med school clerkship shelf, ACP in-training and ABIM board exams.