Anterior segment of eye Flashcards
ciliary body connects anteriorly to the
iris
ciliary body connects posteriorly to
choroid
cornea continues as
sclera
Ciliary body the iris and the choroid are part of the
Uvea
Most inflammation in the eye stems from
Uvea
What gives you red eye
anterior segment pathology
infection
inflammation
irritation
Rare exception of red eye can be due to
acute angle closure glaucoma
Everything in the posterior segment of the eye is
PAINLESS
3 EXCEPTIONS to painless vision loss
- optic neuritis
- GCA
(optic nerve inflammation)
overactive meibomian glands can lead to
blepharitis
common in patients with rosacea
what can be used in a low dose to treat belpharitis?
Dox or Minocycline
If a meibomian gland gets blocked
internal stye vs external
dont need Abx
Blocked oil glands if acute it’s called
Hordeolum = stye
External oil gland blockage
Hair follicle
Internal oil gland blockage
meibomian gland
Chronic oil gland blockage can lead to
chalazion
Orbital cellulitis is
an emergency - can blind patient
- compartment optic nerve compression
4 “NO”s in preseptal compared with orbital cellulitis
1) NO PROPtosis
2) no pain with EOM
3) NO limitation of EOM
4) NO optic disc edema
GLOBE IS WHITE
PERL pupils
PERL
pupils equal and reactive to light
Bacteria in preseptal vs orbital cellulitis
preseptal - usually from skin - staph, strep pnemo, H flu
orbital - usually from nose- Staph, strp pneumo, Beta hemolytic strep
2 bacteria that distinguish preseptal from orbital cellulitis
In pre septal includes H flu
In orbital includes hemolytic strep
In spontaneous subconjunctival hemorrhage
NO effect on vision
always self-limited
DONT stop anti-coag therapy
2 Key signs of bacterial conjunctivitis
PURULENT discharge
NO preauricular lymph nodeds
First thing that should come to mind with HYPERpurulent conjunctivitis
Nisseria gonorrhea -EMERGENCY
- can perforate cornea!
IV ceftriaxone
Classic Hx of viral conjunctivitis
starts in one eye, moves to other
Signs/symptoms viral conjunctivitis
- pre-auricular lymph node
- teary discharge, NO PUS
- ITCHY!
- pseudomembranes
treatment for viral conjunctivitis
symptoms relief, lubrication and cool compress
Post-infection with viral conjunctivitis can get
subepithelial infiltrates inside the cornea stroma
Allergic conjunctivitis
both eyes
seasonal
- itchy!
Giant papillary conjunctivitis is
in contact lens wearers
-
Both allergic and viral conjunctivitis - what type of discharge?
watery
Conjunctival reaction in viral vs allergic and bacterial conjunctivitis
In viral it’s follicular! others papillary
Inflammation of superficial scleral vessels gives you
episcleritis vs scleritis (deep)
Scleritis
VERY painful!
- diffuse or sectoral
- think systemic problem - collagen vascular
Distinguish episcleritis from scleritis on exam
phenylephrine blanches vessels in episcleritis, not in scleritis
Difference between corneal abrasion vs ulcer
Ulcer - infection - white - blocks view of iris
- ulcer may have hypopyon
Corneal abrasion will appear ? on fluorescin exam
clear - it’s a scratch
Corneal ulcers are common in
contact lens wearers
how do you treat corneal abrasion vs ulcer
prophylactic in abrasion
but q1h for ulcers - Fluoroquinilones
3 features of corneal ulcers - EMERGENCY
- WHITE opacity
- contact lens wearer
- possible hypopyon
DO NOT ALLOW PATIENTS TO USE
topical anesthetics
HSV leading to keratitis
- see a dendrite with end bulbs
treat with topical or oral antiviralss
SHOULD NOT prescribe what in HSV infection
STEROIDS!
If HSV zoster shows up near tip of nose and eye - how do you treat?
- treat SYSTEMIC antivirals for 1 week
- no topical!
- REFER if red, painful or blurred vision
What do the dendrites look like in Herpes simplex vs zoster
Simplex - dendrites
Zoster- pseudodendrites
Iritis can be caused by
Psoriatic Arthritis
- AS
- Crohn’s
- idiopathic RA
- Sarcoid
- syphilis
- TB
Hypopyon is
a severe form of iritis
Iritis can cause
- posterior synechiae - adhere to lens
- glaucoma -
A red eye, with pain, photophobia, decreased vision, or limbal redness should
refer
Endophthalmitis is
inflammation of every internal layer of the eye inside the sclera
- usually infectious!
If a patient has a history of ocular surgery, and presents with a hypopyon,
endopthalmitis
-
Signs/symptoms of endophalmitis
- SEVERE pain
reduced vision
Hypopyon
Recent eye surgery
Treatment of endophalmitis
- Intravitreal Abx - topical +/- IV
Headache, nausea, vomiting, red eye, pain, blurred vision: signs of
acute angle closure glaucoma
On physical exam, AACG wil present as
Fixed mid-dilated pupil
