Ch. 7 Adult Eye/Lid Disorders (E1) Flashcards by Danielle Perez

Acute infection caused by staph aureus.
s/s: localized red, swollen, acutely tender are on the upper and lower lid

Hordeolum

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Abscess of the gland of Zeis

External Hordeolum (stye)

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How do you treat a hordeolum?

Warm compresses and antibiotic ointment (bacitracin or erythromycin) to the lid

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Common granulomatous inflammation of the a meibomian gland that may follow an internal hordeolum

Chalazion

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s/s: hard, nontender swelling on the upper and lower lid with redness and swelling of the adjacent conjunctiva

Chalazion

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common chronic bilateral inflammatory condition of the lid margins, commonly caused by conjunctivitis

Blepharitis

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s/s red-rimmed eyes and scales or collarette (dandruff) clinging to lashes
(often involves the lid skin, eyelashes, and associated glands. can be ulcerative or seborrheic)

Anterior blepharitis

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anterior blepharitis treatment

eyelid hygiene (scrub w/ baby shampoo/massage)
Antibiotic ointment (bacitracin/erythromycin)
Warm compresses

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s/s:
lid margins are rolled inward (mild entropion)
tear film may be frothy or abnormally greasy
hyperemic lid margins (inflammation of the eye lid)

posterior blepharitis

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treatment of posterior blepharitis with inflammation of the conjunctiva and cornea

low-dose oral antibiotic therapy for 2-4 weeks
(tetracycline, doxycycline, minocycline, erythromycin, azithromycin)

Topical corticosteroids (prednisolone) and topical antibiotics (Ciprofloxacin) for 5-7 days

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inward turning of the lower lid

Entropion

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Outward turning of the lower lid

Extropion

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Infection of the lacrimal sac usually due to congenital or acquired obstruction of the nasolacrimal system

Dacrocystitis

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s/s
- pain, swelling, tenderness, and redness in the tear sac area
- purulent material can be expressed

Acute dacrocystitis

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Acute dacrocystitis treatment

PO Augmentin, cephalexin, cipro, clindamycin, or triemethoprim-sulfamethoxazole

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Inflammation of the mucois membrane that lines the surface of the eyeball and inner eyelids

Conjunctivitis

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how is conjunctivitis transmitted

-direct contact of contaminated objects
-respiratory secretions
- contaminated eye drops

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s/s
-watery eye discharge
- follicular conjunctivitis

Viral conjunctivitis

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what treatment is DISCOURAGED with viral conjunctivitis

topical antibiotic and steroids

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treatment of viral conjunctivitis

frequent hand and linen hygiene

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s/s
-purulent eye discharge and eyelid matting
-blurring of vision and mild discomfort

bacterial conjunctivitis

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why is gonococcal conjunctivitis an emergency

cornea perforation

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treatment of gonococcal conjunctivitis

500mg IM ceftriaxone (if pt weighs >150kg, give 1g)
topical antibiotics (bacitracin/erythromycin)
irrigate eye with saline

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how is gonococcal conjunctivitis confirmed

gram stain and culture of discharge

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treatment of Chlamydial keratoconjunctivitis -- Trachoma

single dose of Azithromycin 1g

eye infection after contact with secretions infected with chlamydia

inclusion conjunctivitis

treatment of chlamydial keratoconjunctivitis -- Inclusion conjunctivitis

Doxycycline 100 PO BID x 7days

test used to diagnose dry eyes

Schirmer test -- measures the rate of production of the aqueous component of tears

s/s --EYES itching, tearing, redness, stringy discharge, and ocassional photophobia

allergic eye disease

s/s EYES -conjunctival hyperemia -chemosis (edema)

Allergic conjunctivitis

- occurs late in childhood and early adulthood - more common in the spring - s/s: large "cobblestone" papillae and possible follicles at the lumbus

Vernal conjunctivitis

- chronic disorder of adulthood - s/s: upper and lower tarsal conjunctivas exhibit a papillary conjunctivitis

atopic keratoconjunctivitis

treatment for mild to moderately severe allergic eye disease

Mast cell stabilizers (Cromolyn) Antihistamines (topical/systemic)

Yellowish, elevated conjunctival nodule in the area of the palpeable fissure

pinguecula

fleshy, triangular encroachment of the conjunctiva onto the cornea

Pterygium

pterygium is typically associated with __

prolonged exposure to wind, sun, sand, or dust

corneal ulcers are most commonly due to

infections by bacteria, fungi, viruses, or amoebas

delayed or ineffective treatment of corneal ulceration may lead to

corneal scarring and possible intraocular infection

s/s eye pain, photophobia, tearing and reduced vision, purulent or watery discharge

corneal ulcer

acute painful red eye and corneal abnormality requires ___

emergent referral

contact lens wearers with acute eye pain, redness, and decreased vision require ___

prompt referral

s/s white spot on direct visualization

bacterial keratitis

Tx of bacterial keratitis

emergent referral and topical fluroquinolones (levofloxacin, ofloxacin, norfloxacin, ciprofloxacin)

Treatment of herpes simplex keratitis

topical antiviral (ganciclovir) oral antiviral (acyclovir / valacyclovir)

herpes zoster ophthalmicus-- what predicts involvement of the eye

involvement of the tip of the nose or the lid margin

s/s - malaise, fever, headache, and periorbital burning or itching - vesicular rash - conjunctivitis, keratitis, episcleritis, and anterior uveitis - possible elevated intraocular pressure

Herpes zoster ophthalmicus

tx of herpes zoster ophthalmicus

acyclovir 800mg 5times/day valacyclovir 1g TID x7-10 days Famciclovir 500 TID x7-10 days

s/s corneal infiltrate that may have feathery edges and multiple "satellite lesions"

fungal keratitis

treatment of fungal keratitis

Topical: Natamycin, amphoteracin, voriconazole

s/s - rapid onset of extreme pain and blurred vision (halos around lights) - red eye, cloudy cornea, dilated pupil - Nausea and abdominal pain - hard eye on palpation -- elevated intraocular pressure >50

Acute Angle-Closure Glaucoma

Tx of acute angle-closure glaucoma

Emergent referral Acetazolamide 500mg IV x1, then 250PO QID with topical timolol (to lower intraocular pressure)

tx of chronic glaucoma

Prostaglandin analog gttps

intraocular inflammation

Uveitis

sudden redness and blurry vision often with photophobia

Acute anterior Uveitis

gradual loos of vision, commonly with floaters and retinal lesions

posterior uveitis

pupil is small, poorly reactive, and irregularly shaped with development of posterior synechiae

Nongranulomatous anterior uveitis

presents acutely with unilateral pain, redness, photophobia, and Vision loss

Nongranulomatous anterior uveitis

- sometimes presents with iris nodules - large "mutton fat" keratic precipitates

granulomatosis anterior uveitis

treatment of anterior uveitis

topical corticosteroids

when do you refer a patient with uveitis

acute uveitis: visual loss or severe pain chronic: more than mild visual loss

gradually progressive blurred vision no pain or redness lens opacities

Cataract

when do you refer a patient with cataracts

ADLS are affected by vision impairment

rapid loss of vision-- "curtain" spreading across visual field No pain or tenderness increase of floaters and photopsia (flashes of light)

Retinal detachment

c/o sudden visual loss, abrupt onset of floaters that may progressively increase in severity or occasionally "bleeding into the eye"

Vitreous hemorrhage

Hallmark sign of age-related macular degeneration

Drusen -- hard discrete yellow subretinal deposits

Gradual progressive bilateral visual loss due to decreased blood supply to both the outer retina and the retinal pigment epithelium

Dry age-related macular degeneration

-rapid onset of visual loss - both eyes can be equally affected over a few years - Cased by choroidal new vessels growing under either the retina or the retinal pigment epithelial cells --> accumulation of exudative fluid, hemorrhage, and fibrosis.

Wet age-related macular degeneration

Sudden monocular loss of vision no pain or redness widespread or sectoral retinal hemorrhages

retinal vein occlusions

sudden monocular loss of vision no pain or redness "island of vision" in the temporal field pale retinal swelling w/ cherry-red spot at the fovea

central retinal artery occlusion

sudden loss of vision sudden loss of a discrete area in the visual field in one eye fundus signs of retinal swelling

branch retinal artery occlusion

which diabetic patients require urgent referrals

sudden loss of vision or retinal detachment proliferative retinopathy or macular involvement severe nonproliferative retinopathy unexplained reduction of visual acuity

__ are the hallmark of hypertensive crisis with retinopathy that requires emergency treatment

fundus amormalities

sudden visual loss, usually with an altitudinal field defect and optic disk swelling with pallor

anterior ischemic optic neuropathy

may occur with severe blood loss, nonocular surgeries, severe burns, HD (severe HoTN and anemia) does not cause optic swelling

Posterior ischemic optic neuropathy

- Subacute, usually unilateral, visiual loss - pain exacerbated by eye movements (pain behind eye) - optic disk swelling is usually normal in acute stage but develops pallor - color vision loss

Optic neuritis

__ is strongly associated with demyelinating disease

optic neuritis

optic disk swelling due to raised intracranial pressur

papilledema

treatment for papilledema in patients with with idiopathic intracranial hypertension or transverse venous sinus stenting

Acetazolamide

palsy of any of the 3 cranial nerves can cause

double vision

- ptosis with a divergent and slightly depressed eye - lateral extraocular movements only - dilated pupil that doesn't restrict to light

third nerve palsy

-upward deviation of the eye with failure of decompression on adduction - vertical and torsional diplopia that is most apparent when looking down

fourth nerve palsy

- Convergent squint in the primary position with failure of abduction of the affected eye, producing horizontal diplopia that increases on gaze to the affected side and n looking into the distance - important sign of Increased ICP

sixth nerve palsy

s/s fever proptosis restriction of extraocular movements swelling with redness of the lids

Orbital cellulitis

Corneal abrasion treatment

bacitracin-polymyxin ointment or drops Fluoroquinolone topical ointment for contact wearers

treatment for moderate to severe chemical conjunctivitits

topical corticosteroids and topical and systemic vitamic C

pupillary dilation can potentially precipitate

acute glaucoma

what is a potential complication of treating infectious keratitis with corticosteroids

possible perforation of the cornea