5: Eyes Flashcards
1
Q
Itchy, burning, swollen red lid margin. May have flakes/heavy crusting on the lashes, lid redness and swelling, foam along lid margin.
A
Blepharitis/Meibomian Gland Disease
2
Q
Blocked glands, thickened and telangiactatic lid margin.
A
Blepharitis/Meibomian Gland Disease
3
Q
T/F Blepharitis/Meibomian Gland Disease can be associated with acne rosacea.
A
True
4
Q
_____ is the main cause of bacterial conjunctivitis in adults.
A
Blepharitis (Blepharonconjunctivitis)
5
Q
What is the treatment for blepharitis (4)?
A
- Wash lashes with baby shampoor or lid scrubs.
- Warm compresses.
- Artificial tears.
- ABX/steroid combo if lid is very inflamed.
6
Q
When treating blepharitis with ocular topical steroids, what do you need to monitor?
A
Intraocular pressures
7
Q
Internal or external “stye.”
A
Hordeolum
8
Q
Infection of glands around the eyelid that is painful to palpation.
A
Hordeolum
9
Q
Inflammation of glands around the eyelid that is not painful to palpation.
A
Chalazion
10
Q
Which usually comes first, a hordeolum or a chalazion?
A
Hordeolum. Chalazaions often begin as hordeolums.
11
Q
What is the treatment for hordeolum or chalazion (4)?
A
- Warm compresses for 10 min with lid massage.
- If large and painful, consider oral ABX.
- If chronic, oral doxy 100 mg BID.
- If no resolution within 2 weeks, refer (may need excision).
12
Q
Lid turning inward.
A
Entropion
13
Q
Lid turning outward.
A
Ectropion
14
Q
Entropion and ectropion can be involutional or cicatricial (related to _____).
A
Alopecia
15
Q
Entropion/Ectropion results in _____ and/or _____.
A
Dry eyes
Excessive tearing
16
Q
Inability to close the eyelid completely.
A
Lagopthalmos
17
Q
Lagopthalmos can be associated with _____.
A
Exopthalmos (hyperthyroidism)
18
Q
What is the treatment for lagopthalmos (3)?
A
- Evert the lash line.
- Thick ocular ointment (Refresh PM).
- Refer to oculoplastic surgeon.
19
Q
_____ is the most common cause of eyelid dermatitis, especially if bilateral.
A
Contact dermatitis
20
Q
Itchy red eyelids that can be caused by preservatives in topical agents, cosmetics, hair products, etc.
A
Contact dermatitis
21
Q
Management of contact dermatitis (4)?
A
- Stop causative agent.
- Cold compresses.
- Preservative-free tears.
- Topical/oral antihistamines.
22
Q
T/F Most causes of adult conjunctivitis are bacterial (“pink eye”).
A
False. Most causes of adult conjunctivitis are viral or allergic.
23
Q
Itchy with mild injection. Happens mostly in kids and young adults. Look for papillae on palpebral conjunctiva.
A
Allergic conjunctivitis
24
Q
What is the management for allergic conjunctivitis (1)?
A
Topical antihistamine (Alaway, Zaditor, or Patanol BID).
25
"Pink" eye with possible mucus. Mostly follicles on palpebral conjunctiva. Tearing and burning. Usually starts in 1 eye and spreads to the other.
Viral conjunctivitis
26
With viral conjunctivitis, the patient may have inflamed PAN (polyarteritis nodosa). Often associated with _____.
URI
27
Management for viral conjunctivitis (3)?
1. Highly contagious: change pillow cases, towels, cosmetics, etc.
2. Preservative-free tears.
3. Cold compresses (self-resolving in 2-3 weeks).
28
When should viral conjunctivitis be referred?
If vision is affected or there is pain with blinking.
29
Beefy red conjunctiva, major discharge, itching/irritation.
Bacterial conjunctivitis
30
Management for uncomplicated cases of bacterial conjunctivitis (1)?
Topical ABX.
31
What is a cause of newborn bacterial conjunctivitis and how is it treated?
Ophthalmia neonatorum d/t N. Gonorrhea. Needs IV fortified ABX.
32
In kids, if bacterial conjunctivitis is hyperacute, what might be the cause?
N. Gonorrhea. Treat with oral/IM ABX.
33
This type of bacterial conjunctivitis is typically recurrent and does not respond to treatment.
Chlamydia (oral ABX).
34
Hemorrhage of the eye.
Subconjunctival hemorrhage
35
What should you r/o with subconjunctival hemorrhage?
HTN (check BP)
36
Management of subconjunctival hemorrhage (3)?
1. Avoid blood thinners, if possible.
2. Avoid heavy lifting/strenuous activity.
3. If recurrent, do blood work.
37
What is the best way to detect most corneal diseases?
Slit lamp with a cobalt blue light filter and fluorescein dye.
38
Affects 10-30% of population over 40. Symptoms of burning, foreign body sensation, itchiness, excessive tearing. D/t poor tear film quality or inadequate quantity.
Keratoconjunctivitis Sicca (Dry Eye)
39
What is used to diagnose keratoconjunctivitis sicca?
Schrimer's test (Eyes are numbed. Paper placed inside eye. After 5 minutes, measure the amount of moisture. Normal is more than 10 mm).
40
What is management for keratoconjunctivitis sicca (4)?
1. Artificial tears 2-4x/day.
2. Warm compresses.
3. Restasis (cyclosporine) if severe.
4. Avoid Visine and drops with vasoconstrictors (rebound effect).
41
When do you refer the patient with red eyes (5)?
1. Pain
2. Photophobia
3. Change in vision
4. Hx of recent contact lens wear
5. No improvement with treatment
42
Infection of soft eyelid tissue anterior to the lid septum.
Preseptal Cellulitis
43
Often starts as hordeolum that spreads to entire lid.
Preseptal Cellulitis
44
What are 4 causes of preseptal cellulitis?
1. Hordeolum
2. URI
3. Sinus Infx
4. Open Wounds
45
What is the management for preseptal cellulitis (2)?
1. Oral ABX (Augmentin or Keflex x 10 days).
| 2. Warm compresses.
46
When should you hospitalize with preseptal cellulitis (2)?
1. Suspect orbital cellulitis.
| 2. <5 years of age.
47
Inflammation of the thin layer of tissue between the conjunctiva and sclera. Mild pain/tenderness that is often sectorial, can be nodular. Most cases are idiopathic (can be associated with systemic condition such as IBD, RA, SLE, etc.).
Episcleritis
48
What is a clinical pearl that can help diagnose episcleritis?
Redness will blanch with 10% topical phenylphrine and episcleral vessel will be mobile on palpation.
49
When is blood work warranted with episcleritis (2)?
1. Bilateral
| 2. Recurrent
50
Management for episcleritis (2)?
1. Self-resolving in 2-3 weeks.
| 2. Topical steroid drops help with comfort and recovery.
51
More pain. Sclera is deeper red with a blue hue. Usually diffuse, but can be sectorial.
Scleritis
52
How do you tell the difference between episcleritis and scleritis?
Scleritis does NOT blanch with topical phenylphrine.
53
T/F Patients need to be dilated with scleritis.
True. Need to look for iritis and posterior scleritis.
54
What are 2 significant risks with scleritis?
1. Perforation
| 2. Visual loss
55
Which is more systemic, episcleritis or scleritis?
Scleritis
56
What is management for scleritis (2)?
1. Same-day referral to ophthalmologist.
| 2. Oral anti-inflammatory (Ibuprofen 800 mg or Indomethacin) + topical agents.
57
Redness/irritation, aching pain, increased tearing, photophobia, secondary iritis and trabeculitis, stromal keratitis, skin vesicles.
Herpes Simplex of the eye
58
Has true dendritic ulcers.
Herpes Simplex of the eye
59
How are dendritic ulcers best seen?
With Rose Bengal or Lissamine Green staining.
60
What is the management for ocular herpes (2)?
1. Topical antiviral (Trifludine 7x/day or Ganciclovir 5x/day) and/or
2. Oral antivirals (Zovirax, Valtrex).
61
What would you suspect with a positive Hutchinson's' sign?
Herpes zoster. Vesicles on the tip of the nose, or vesicles on the side of the nose, precedes the development of ophthalmic herpes. This is true if it affects the ophthalmic branch of the trigeminal nerve.
62
Ocular lesions occur _____ days after initial skin rash with herpes zoster.
2-3 days
63
Conjunctivitis is common. Ulcers have a tapered end (pseudodendrites). Can affect stromal tissue, often causing scarring.
Herpes zoster
64
What can herpes zoster be associated with?
Necrotizing retinitis
65
What is the management for herpes zoster (2)?
1. Refer to ophthalmology.
| 2. Oral antiviral (does not respond to topical).
66
Severe ocular pain. Injection that is more severe toward main location.
Ulcerative Keratitis
67
Ulcerative keratitis is mainly associated with _____.
Overwear/overnight wear of soft contact lenses.
68
Management for ulcerative keratitis (3)?
1. Same-day referral.
2. Do not patch the eye!
3. Fortified topical ABX q 30 min-1 hour and daily follow-ups.
69
How is the causative agent found in ulcerative keratitis and which 2 are most common?
1. Needs cornea scraping and culture.
| 2. Most often Pseudomonas or Strep.
70
What are 3 other types of ulcerative keratitis not caused by contact lens wear?
1. Autoimmune (RA)
2. Peripheral ulcers
3. Sterile ulcers (inflammation from severe Staph blepharitis)
71
Most common type of glaucoma?
Open Angle (Wide Angle) Glaucoma
72
This is a chronic condition where the intraocular pressure increases slowly.
Open Angle (Wide Angle) Glaucoma
73
This is an acute condition with a sudden increase in ocular pressure.
Narrow Angle Glaucoma
74
This is caused by an anatomical barrier to the flow of aqueous.
Narrow Angle Glaucoma
75
Which type of glaucoma has pain?
Narrow Angle Glaucoma
76
What ocular pressure can be seen with narrow angle glaucoma?
>50-60 mmHg (normal is 12-22).
77
With acute angle glaucoma, the pupils are usually ______.
Dilated. Usually happens in dim conditions.
78
Pain, photophobia, headache, n/v, red eyes, tearing, blurred vision, mid-dilated pupil.
Narrow Angle Glaucoma
79
_____ causes blurred vision in narrow angle glaucoma.
Swollen cornea
80
What is the treatment for glaucoma (2)?
1. Need to lower IOP immediately. Use Pilocarpine 1% (if IOP <40) or IOP-lowering agents (BB, alpha agonist, CAI [carbonic anhydrase inhibitors], oral Diamox).
2. Refer for laser peripheral iridotomy.
81
What is the IOP needed to refer for laser peripheral iridotomy?
<30 mmHg
82
Cells in the anterior chamber, white deposits on the corneal endothelium; cornea can be swollen; sluggish reaction of pupils if synechiae (iris adheres to cornea or lens).
Uveitis
83
Types of uveitis (10)?
1. Anterior
2. Intermediate
3. Posterior
4. Panuveitis
5. Idiopathic
6. Granulomatous
7. Nongranulomatous
8. Acute
9. Chronic
10. Recurrent
84
When do you refer immediately with uveitis and why?
If hypopyon present to r/o endophthalmitis. Hypopyon is inflammatory cells in the anterior chamber of the eye.
85
Pain, redness (limbal flush), photophobia, epiphoria, decrease in vision.
Uveitis
86
What systemic symptoms can occur with uveitis (4)?
1. Back pain
2. Joint pain
3. Skin rash
4. Diarrhea
87
Erythema of the ciliary vessels, 360 degrees around cornea.
Limbal flush
88
Overflow of tears onto the face.
Epiphoria (Epiphora)
89
Management of uveitis (1)?
Topical steroid + cycloplegic agent.
90
When do you do a systemic workup for uveitis (4)?
1. Recurrent
2. Bilateral
3. Granulomatous
4. Posterior
91
Uveitis is associated with what 9 conditions?
1. TB
2. Sarcoidosis
3. IBD
4. Syphilis
5. SLE
6. Behcet Disease (rare disorder that causes blood vessel inflammation throughout your body)
7. Lyme Disease
8. Herpes
9. Toxoplasmosis
