Causal Conditions Flashcards
What is blepharitis?
Types
Presentation
Complications
Tx
Inflammation of the lid margins
2 types:staph aureus ~ crust around the eyelashes OR seborrheic ~ greasy & dandruff lesions at base eyelids
Features: crusting, itching, tearing, foreign body sensation, lid margins red & thickened
Complications: hordeola recurrent, conjunctivitis, corneal ulceration, keratitis
Tx: warm compresses, lid massage, lid washing, artificial tears
What is a hordeolum?
Stye - acute inflammation of the eyelid gland
Types: meibomian ~ internal gland, Moll ~ external gland (commonly), Zeis ~ modified sweat gland
Usually cause staph A.
Localize to lid margin after a couple days
Painful, red, swollen
Tx: warm compresses, massags, should resolve 1-2 weeks
What is a chalazion?
Granulomatous inflammation of a meibomian gland
Preceded by hordeolum of meibomian gland (internal)
Red, pain, edematous, but over time becomes small, non painful, never localizes to lid margin
DDX: BCC, sebaceous adenoma, meibomian carcinoma
Tx: warm compresses ~ no resolution in 1 mon ~ removes
Continues to re-occur, re-examined for malignancy
what is a foreign body?
Foreign body on or in the cornea
Presents red eye, pain, tearing, foreign body sensation, photophobia
Complications: ulcer, infection, secondary iritis, rust ring in visual field
Dx: slit lamp, magnification, fluorescen stain
Tx: drummel to remove it under microscope or refer to optho
What is preseptal cellullitis?
Inflammation of the structures anterior to orbital septum
Usually from trauma, infection ~ bite, sinus, chalazion, conjunctivitis
Can progress to orbital cellulitis
Present: lid edema, no ∆ vision & mobility of eyes & no pain with eye movement
Tx: amoxi-clav ~ if severe or <1 yo = tx orbital cellulitis
What is orbital cellulitis?
Inflammation of the structures POSTERIOR to orbital septum
EMERGENCY
Present: lid edema, erythema of conjunctiva, diplopia/vision ∆, pain eye movement, decreased eye movement, fever, proptosis, chemosis
Causes: preseptal cellulitis, sinus infection (ethmoid), trauma, tooth infection
Complications: optic nerve inflammation, brain abscess with visio loss, meningitis
Tx: ceftriaxone + vanco IV, 2x blood cultures
Conjunctivitis
Bacterial ~ purulent discharge, staph, strep or chlamydia,
Viral ~ serous discharge, HSV, herpes zoster, CMV, adenovirus ~ self limiting ~ pink eye
Allergic ~ irritant ~ smoking, fumes, ~ asthma, rhinitis, sinus pressure,
Present: chemosis ~ bacterial, itchy ~ allergic, redness wtih scleral sparring (peri-limbic sparring), discharge, crust forming eyelids in morning, no changes to vision, no eye pain
Tx: viral ~ warm compresses, bacterial ~ topical antibiotics, chlamydia ~ oral azithromycin/doxcycline, allergic ~ antihistamines
Subconjunctival Hemorrhage
Blood beneath conjunctiva
Otherwise asx
No pain, no nothing
If 360 involvement ~ consider globe rupture
Should resolve 2-3 weeks
Causes: idiopathic, valsava, trauma, HTN, anticoagulation, bleeding disorders
Episcleritis
Inflammation of episclera (bw conjunctiva & sclera), idiopathic, self-limiting
Hyperemia isolated to a specific area (bulbar conjunctiva) ~ conjunctivities generalized hyperemia
No discharge, no lacrimation
No pain & no photophobia~ different than scleritis
Tx: self-limiting
Scleritis
Inflammation sclera & episclera
CAN THREATEN VISION
Present: severe eye pain (affects sleep & appetite), lacrimation, hyperemia (blue-purple), sparring palpebral conjunctiva
Common in women & connective tissue disorders (SLE, RA)
Tx: corticosteroids & tapering
Px: 18% lose visual acuity in 1 years, ?30% lose in first 3 years
Complications : perforation of eye & lose eye
Pinguecula
Hyaline & elastic tissue deposition on nasal or temporal limbus sparring cornea
Benign
Causes: wind & sun exposure, aging
Can get it removed ~ cosmetically
Irritative sx: lubricating drops
Pterygium
Fibrovascular, triangular wing like thing extends onto cornea
May induce astigmatism, decrease vision
Removed ~ affecting vision, chronic inflammed, cosmetically
Irritative sx: tx lubricating drops
Herpes Zoster Opthalmicus
Herpes zoster, involved 1 branch TG nerve
Covers eyelid, vesicular rash
Pain, photophobia, red eye, tearing
Antiviral immediately
Complications: keratitis, perforation, ulceration, scarring
Keratitis
Inflammation cornea
Usually from HSV ~ may lay dormant in dorsal n.root until activated again
Dendritic lesion on cornea seen with fluorescein stain
Pain, red eye, tearing, decreased vision, foreign body sensation
Complications: scarring, secondary iritis, secondary glaucoma
Tx: antivirals (trifluridine - topical) or acyclovir (oral)
Why would we not prescribe steroids for ocular disorders?
Increase IOP, impair corneal healing, exacerbate herpetic keratitis
Photokeratitis
Occurs from welding light or UV radiation to cornea
Appears 6-12 hr post (latency period is key)
Present: bilateral eye pain, photophobia, inability to open eyes, foreign body sensation
Tx: resolve on it owns
What is uveitis?
Anterior, intermediate or posterior or all 3 at the same time
Inflammation of 1orall: iris, ciliary body, choroid
Anterior Uveitis
Iritis plus inflammation ciliary body
Idiopathic or assoc. connective tissues diseases (ankylosing spondylitis, psoriatic arthritis)
- HSV, lyme disease, TB, syphilis
Presentation: eye pain, brow ache, photophobia, hypopion ~ pus anterior chamber, ciliary flush, decreased VA
Unilateral
Complications: senechiae (posterior iris stuck lens ~ weird iris look) ~ angle closure, decreased IOP ~ severe: inflammatory glaucoma
Tx: mydriatic to dilate iris ~ prevent senechiae, relax muscles not as much pain
E.g. phenylephrine
Intermediate uveitis
Vitreous inflammation
Unilateral, insidious onset of blurred vision, vitreous floaters, snowback appearance (inflammatory cells)
Associated with anterior uveitis
Idiopathic ~ lyme disease, sarcoidosis
Complications same as anterior but only —-> glaucoma, cataracts, macula edema
Tx: immunosuppressants & steroids
Posterior uveitis
Inflammation choroid, retina
Choroid has no innervation ~ painless = changes VA, floater, hypopyon
Complications: vitritis, visual field loss, macular edema
Causes: Bacterial - syphilis, tB Viral - CMV, HSV Fungal/parasitic Metastatic lesion
Cataracts
Any opacity to lens
Causes:
- old age
- DM
- metabolic disease
- hypocalcemia
- uveitis
Sx: progressive, painless, loss VA
- halos around lights at night
- monocular diplopia
- dim
Tx: surgery
Dislocated lens called
Ectopia lentis
Decreased VA
Iridodenesis ~ quivering iris
Abnormal red reflex
Complications: uveitis, cataracts, glaucoma
Tx: surgical
Retinal artery occlusion
Cause
Sx
Fundoscopy & exam
Tx
Occlusion - ischemia - vision loss
Cause: 1) embolus,2) thrombus, 3) temporal arteritis
Sx: sudden painless, monoccular vision loss
RAPD
Fundoscopy ~ cherry red lesion, surrounding retina pale
Have to restore blood flow within 2 hr = irreversible damage
Compressing the eye = dislodge the embolus
Retinal vein occlusion
Patho unknown, arteriosclerotic ∆ artery = share common sheat affects v.?
Sx: sudden/gradual, painless vision loss
Fundoscopy = thunder & storm look - retinal v. Engorgement, macular edema, retinal Hemorrhages, swollen optic disc
