617 the eyes

Question 1

Blepharitis- Inflammation of the eyelids

Answer 1

Anterior and posterior
Anterior cause by staphalococcus aurea
Posterior is mostly sebacious glands
Swollen eyelids, inflamed lid margins, scaling, crusting, ulceration, altered eyelash appearance

Question 2

Blepharitis-Physical and treatment

Answer 2

PE-external eye structure: eyelids, eye lashes, maibomium glands, eyebrows, scalp, ears, base of the nose for seborrhea
TX: Careful cleansing of eyelids to remove oils
Q-tip and baby shampoo. warm, moist compresses, Antibiotic ointment such as erythromycin or bacitracin.
Avoid use of contact lenses and use good hand hygeine
Scrubs- 2-4 times per day

Question 3

Hordeolum

Answer 3

inflamed area of eyelid where the eyelash meets the eyelid. Bacteria gets in the oil glands.Similar process of a pimple.

Question 4

Hordeolum

Answer 4

swollen and red bump on the eyelid. gritty , scratchy sensation, sensitivity to light, tearing, tenderness on the eyelid

Question 5

Hordeolum

Answer 5

PE: HEENT and eyelid and eye structures
TX: warm compresses to the eye 10 minutes 4x/day
Do not squeeze. Let drain on their own. daily lid scrubs
Antibiotics if infected.
Replace makeup

Question 6

Chalazia

Answer 6

A gradually localized enlarging nodule caused by lipgranuloma blockage in the meibomian gland that lubricates the eye.
Usually painless

Question 7

Chalazia-PE and TX

Answer 7

PE: HEENT, single or multiple, palpable, nontender, soft and usually fluctuant
TX: Warm compresses, daily lid scrubs with gentle massage.
Follow up with pain or swelling longer than 1 month or additional lumps or eyelash loss.
Antibiotics of no use

Question 8

Viral conjunctivitis

Answer 8

inflammation or swelling of the membrane lining of the eyelid caused by a virus (adenovirus). Gritty feeling in the eyes, increased tearing, watery discharge, redness, itching, pain, blurred vision, sensitivity to light, HA, fever, nasal congestion, post nasal drip and cough

Question 9

Conjuctivitis-viral
(eyes glued shut in the am)
one eye then the other
recent URI

Answer 9

PE: Eye structures, C&S, nose, thorat, mouth, CV, respiratory, cerical and preauricular lymph nodes
TX: cool compresses, hand hygiene, contact lense cleaning, or disposal. Change pillow case daily. Do not share towels or handkerchiefs
Come back in a week if not gone

Question 10

Conjunctivitis-allergic

Answer 10

Inflammation or swelling of the eyelids due to an allergy causing substance. Histamine is released into the blood and the blood vessels in the conjunctiva become swollen

Question 11

Conjunctivitis-Allergic

Answer 11

red, itchy, puffy eyes (both), tearing, stringy white discharge, Hx of seasonal allergies

Question 12

Conjunctivitis-Allergic

Answer 12

PE: eye structures, red eyes, dilated bessels in conjunctiva, puffy eyelids, tears, nasal mucosa, throat, CV, respiratory.
Will have chiners under the eyes (dark circles), boggy nose
TX: no contacts- cool compresses-oral anti-histamines-artificial tears, naphcon A Vasocon (otc), Levocabastine

Question 13

Conjunctivitis-bacterial

Answer 13

infection of the conjunctiva membrane lining the eyelid. Tears contain enzymes and antibodies that kill bacteria

Question 14

Bacterial conjunctivitis

Answer 14

blurred vision, crust or matted discharge forming on eyelid overnight, thick mucoid discharge, early morning glued shut, absence of itching.
PE: HEENT, eye structures, swab for culture and sensitivity
TX: antibiotic drops or ointment.-Tobramycin, fluroquinolones, trimethoprim-polymixin B
Warm compresses, hand hygiene, contact lense dispose or clean, change pillowcases daily, dispose of eye cosmetics. Do not share towels, etc.

Question 15

Corneal abrasion

Answer 15

A cut or scratch or abrading of the thin, clear, protective coat of the anterior portion of the ocular epithelium often the result of trauma

Question 16

FNP can treat minor abrasion

Answer 16

Do not patch. Supportive care. May use a an antibiotic to lubricate. Do not rub. No topical anesthetics. Should be better in 24-72 hours

Question 17

Corneal abrasion

Answer 17

Fluorescein staining

• put dye on the eye surface
• use cobalt blue light
• light causes the dye to glow green and you can see damage.

Question 18

Iritis

Answer 18

swelling and irritation of the uvea, the middle part of the eye which provides the blood supply to the retina. Most common is the iritis. which affects the anterior portion of the meddle eye or the iris

Question 19

Iritis

Answer 19

blurred vision, dark floating spots, pain, light sensitivity, hx of rheumatoid arthritis, ankylosing spondylitis, infections or toxin exposure.
PE: visual acuity, opthalmic exam
Labs-ESR, ANA
TX: underlying condition, dark glasses, steroid drops, refer for loss of vision or pain

Question 20

Ciliary flush

Answer 20

Dilation of blood vessels immediately surrounding the cornea
Hx of angle closed glaucoma and uveitis, red eye, sudden pain, light sensitivity, n/v, ha, use of contacts
PE: Eye exam, nose, mouth, throat, CV, resp, conjunctival, blood vessels are dilated
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