#14 Red Eye assessment Flashcards
What are the lymph nodes of the head and neck?
Preauricular, Tonsillar nodes (at the angle of the mandible), submandibular
Which of the lymph nodes will have a tenderness to it when palpating patients with Herpes Simplex and Zoster?
Submandibular
Which lymph nodes has an infections of the skin at back of head and frequently enlarged during upper respiratory infections such as Monoucleosis and German Measles?
Posterior cervical lymph nodes
How do the lymph nodes feel with palpation when the body is fighting an infection?
Firm, Tender, Enlarged, Warm (not always)
How do the lymph nodes feel with palpation when the body is having a maglignant disease?
Firm, Non-tender, Fixed, increase in size over time
In what condition would the supraclavicular lymph node swollen?
Chest/abdomen disease such as TB and cancers(lymphoma)
When would you check for lymphadenopathy?
In all cases of red eye
What are the vital signs of optometry?
VA, EOM, pupil
What should you check before slit lamp in a problem focused situation in the case of red eye?
- History
- VA
- Gross observation (gross inspection of injection, check lymphadenopathy, check sinuses)
What are the symptoms that patients have with allergies or sinus infections?
congestion, post-nasal drip, headaches/facial pain over brow, under eyes, or behind eyes.
Percussion is to tap directly over both brows using the ______ finger. Then repeat for each maxillary using the _____ finger to check for pain or tenderness.
middle, index
Which sinus is not accessible to palpation or transillumination?
ethmoid and sphenoid
When using the transillumination method to check for sinuses obstruction, + glow means ______, and - glow means ______.
open, blocked or thickened sinus
Where do you position the transilluminator when observing the frontal sinus?
a. above the supraorbital rim
b. under the supraorbital rim
b
Where do you position the transilluminator when observing the maxillary sinus and what do you ask the patient to do for you?
place light directly on the infraorbital rim and ask the patient to open their mouth.
Do you need to do Gonioscopy with red eye patients?
Yes, check if the angle are close due to cells or flare
What anterior structures you have to check with red eye patients?
- Lid and lashes looking for crusting and MGD
- Palpebral and bulbar conjunctiva
- Cornea - direct, indirect, retro and stain cornea with Fluorescent
- Anterior chamber
- Tono
- Gonio
What dye do you have to use with red eye patient when looking at their cornea when scanning for epithelial defects?
fluorescent dye
T/F Epidermic keratoconjunctivitis (EKC) is not contagious.
False, EKC is very contagious. Make sure to wash hands and clean slit lamp.
What is Keratic Precipitates?
They are inflammatory WBC deposits on the corneal endothelium
How does acute KP looks like?
white and round
How do old KP look like?
irregular, faded and/or pitmented
What does it mean if you see KP and cells?
sign of uveitis
What are the intraocular inflammations associated with KP?
Iritis, Uveitis, post-opt cataract or laser peripheral iridotomy (LPI) surgery
What is the most useful or common method of illumination when viewing KP?
parallelepiped with direct beam
What is the 2nd most useful or common method of illumination when viewing KP?
Indirect
What are the signs of angle closure glaucoma?
- elevated IOP (50)
- angle closed with gonio
- deep conunctival and episcleral injection greatest at limbus
- mid-dilated pupil
- corneal edema (steamy cornea)
Glaucoma screening includes measurement of ____, stereoscopic assessment of _________, and screening of __________.
IOP, optic nerve head, central visual field.
___% of patients develop glaucoma despite apparently normal eye pressure.
~50
What is Primary Open Angle Glaucoma (POAG)?
The anterior chamber angle is open and there are NO secondary causes to increase the IOP
T/F Open angle Glaucoma is the most common glaucoma in the US.
True
How is the optic nerve damage due to primary open angle glaucoma?
optic neuropathy that is chronic and progressive with a characteristic acquired loss of optic nerve fibers
What is IOP difference between the two eyes when you do suspect primary open angle glaucoma?
more than or equal to 3mmHg
What are you thinking about if the patient’s IOP is more than of equal to 3 between the two eyes?
it can be glaucoma, retinal detachments or uveitis/iritis
What is the abnormal diurnal variation of IOP measurement over the course of an 8 hr clinic day?
a. 3mmHg
b. 5mmHg
c. 8mmHg
d. 4mmHg
c. greater than 5mmHg is abnormal
How to calculate Ocular Perfusion pressure?
Diastolic BP - IOP
Peak IOP pressure occurs during when?
sleep
In obese patients, valsalva movement when measuring IOP using GAT can cause an increase in _________.
episcleral venous pressure
_________ is most often associated with higher than average central corneal thickness?
ocular hypertension
Based on the ocular hypertension treatment study, what cause the greater risk of developing primary open angle glaucoma?
thin cornea (under 545microns)
Is race a factor for developing glaucoma?
Yes
What is the average cornea thickness?
540 to 545 microns
Pachymetry is use to measure the _______.
central corneal thickness
Pachymetry is now standard of care for ________ and _______ in optometry.
glaucoma, LASIK Co-management
What is the PASCAL Dynamic Contour Tonometer (DCT)?
It’s a new alternative to GAT. It uses the contour matching that includes the influence of corneal thickness, rigidity, curvature and elastic properties
In PASCAL Dynamic contour Tonometer, a complete measurement cycle requires about ___ seconds of contact time.
8
GAT remains the _____ Standard.
Gold
Where do LPI usually perform at on the iris?
at 10 and 2 O’clock position
How do you check if the LPI is open?
use transilluminator
