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HEENOT > Clin Med - Eye > Flashcards

Clin Med - Eye Flashcards

1
Q

corneal ulcer

A
  • Infection of the cornea with loss of overlying epithelium

- Aka “eye infection” or “infection of the clear window of the eye”

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2
Q

Cause of corneal ulcer

A
  • Bacteria (most common)
  • Virus (herpes, etc.)
  • Acanthamoeba (contacts and fresh water, GROSS)
  • More common in: Contact lens wearers, Hx of eye herpes ,Diabetes
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3
Q

Sx of corneal ulcer

A
  • decrease vision
  • pain
  • light sensitivity
  • increased tearing
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4
Q

Dx/Tx of corneal ulcer

A

Can’t dx cause by looking, must sent to specialist who will examine a scraping

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5
Q

Dacryoadenitis

A

acute inflammation of the lacrimal gland

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6
Q

cause of dacryoadenitis

A
  • Inflammatory
  • Malignancy
  • Infection (less common) such as TB and MRSA
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7
Q

Sx of dacryoadenitis

A

red, droopy upper eyelid

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8
Q

Tx of dacryoadenitis

A

abx? (no info given)

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9
Q

Ectropion

A

eyelid flips out

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10
Q

cause of ectropion

A
  • Normal part of aging, skin loses its tone “senile”
  • Mechanical – under-eye bags pull lid down
  • Paralytic – CN VII palsy
  • Poorly done suturing under eye, should suture vertically not horizontally
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11
Q

Tx of ectropion

A

short-term temporizing:
-lubricating ointment
-moisture goggles at night
long-term management: surgery

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12
Q

Entropion

A

eyelid flips in

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13
Q

cause of entropion

A

Overworked orbicularis muscle, spasms, pulls lid in (will often see skin pushed out just under lid lip, this is the muscle)

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14
Q

Sx of entropion

A

lashes up against the eye when lid is flipped in

no Tx listed

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15
Q

Foreign body

A
  • foreign body on surface

- foreign body embedded in cornea

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16
Q

cause of foreign body

A

-seen most often w/ grinding, chipping, hammering, sawing, plumbing, etc.

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17
Q

Sx and complications of foreign body

A

-Decreased vision
-Pain
-Light sensitivity
-Increased tearing
-Thing in eye
Complications:
-Permanent damage
-Vision loss is possible

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18
Q

Tx of foreign body

A
  • Irrigate with sterile saline or eyewash solution
  • Send for evaluation with eye specialist
  • DO NOT try to remove with instrument or fingers
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19
Q

glaucoma

A
  • Disease that damages the optic nerve (optic neuropathy)
  • A blinding disease with characteristic findings
  • Affects both the posterior and anterior compartment
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20
Q

cause of glaucoma

A
  • Changes to the optic nerve and visual fields
  • D/t increased pressure: anterior compartment fluid (aqueous) can’t exit via the trabecular meshwork and get stuck
  • Family hx
  • What actually causes???
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21
Q

Acute glaucoma

A 
EMERGENCY!
-Sudden vision decrease 
-Fixed pupil 
-Pain 
-Redness 
-Nausea/vomiting 
\+/- Headache 
* If untreated, can be blind within 24 hours
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22
Q

Chronic glaucoma

A
  • Slow decreased peripheral vision (can still have 20/20 central vision!)
  • Ultimately loss of central vision
  • Painless – generally not noticed until it is too late
  • Might scan eyes around a lot to get a full picture dt lost peripheral vision
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23
Q

internal eye visual exam in glaucoma

A

“glaucomatous cupping”

  • Greater than 1:2 cup to disc ratio
  • Cup has clearly defined edges, whiter
  • Loss of tiny disc vessels
  • Lack of blood vessels exiting the disc
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24
Q

blepharitis

A
  • Inflammation of the eyelid margin
  • Dandruff-like scales form at the eyelashes base
  • Not contagious
  • Not visually-threatening
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25
Q

causes of blepharitis

A
  • Bacterial (staph)
  • Skin-related condition (rosacea)
  • Allergies
  • Lice / demodex
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26
Q

sx of blepharitis

A
  • Pruritus and burning
  • Soreness of the lid
  • Skin changes (scaly & hyperemic)
  • Photophobia
  • Foreign body like sensation
  • Dry eyes
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27
Q

general tx for blepharitis

A
  • Warm compress
  • Lid scrub (baby shampoo, selenium shampoo)
  • Artificial tear replacement
  • 90% will get better
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28
Q

topical abx tx for blepharitis

A

erythromycin, bacitracin azithromycin

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29
Q

Tx for blepharitis in refractory or severe cases

A

tetracyclines (doxy if caused by rosacea) and azithromycin

if demodex is cause: treat w/ tea tree oil and oral Ivermectin

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30
Q

Blowout Fx

A

With a blunt force trauma to the orbit, the force can cause the orbital floor to fx and “blowout”

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31
Q

Common causes of blowout fractures

A
  • Assault (fist)
  • MVC (dashboard)
  • Falls (elderly)
  • Sports injuries (balls / elbows)
  • Occupational/Industrial accidents
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32
Q

What is the classic triad that often accompanies blowout fx

A
  1. Enopthlalmos (recession of globe
  2. Restrictive strabismus (inf. rectus m. entrapment)
  3. Infraorbital V2 hypoesthesia
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33
Q

other sx/complications associated w/ blowout fx

A
  • 30% have associated globe injury

- in children can be a greenstick fx creating a “trap door”

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34
Q

Cataract

A

condition in which the lens become less opaque

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35
Q

causes of cataracts

A
  • Aging

- Made worse by: smoking, DM, increased UV exposure

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36
Q

sx/complications of cataracts

A
  • Decreased overall vision
  • Difficulty w/ bright lights
  • Difficulty w/ vision in dimly lit situations
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37
Q

Tx of cataract

A

surgery - referral

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38
Q

chalazion

A
  • Chronic granulomatous reaction

- Meibomian glands get clogged and create bump in the lid

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39
Q

cause of chalazion

A
  • clogging of meibomian gland

- sterile

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40
Q

sx of chalazion

A
  • Small lump on eyelid
  • Do not confuse with:
  • Stye
  • Sebaceous cell carcinoma
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41
Q

Tx of chalazion

A

Start conservatively; will usually go away with hot compress and digital massage

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42
Q

conjunctivitis

A

inflammation or infection of the conjunctiva (“pink eye”)

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43
Q

cause of conjunctivitis

A
  • Infections (bacterial and viral)
  • Most common cause: staph, strep or haemophilus aegyptius
  • Allergies (chemical and seasonal)
  • Bacterial can be related to STDs (think Gonorrhea and Chlamydia
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44
Q

sx/complications of conjunctivitis

A
  • Decreased vision
  • Discharge
  • Increased redness of eye and/or eyelids with or w/o swelling
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45
Q

Tx of bacterial conjunctivitis in non contact wearers

A

1st line:

  • erythromycin ointment
  • trimethoprim-polymyxin
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46
Q

Tx of bacterial conjunctivitis for contact wearers

A

1st line:

ocular fluoroquinolones

47
Q

Tx of viral conjunctivitis

A
  • antihistamine/decongestant drops
  • nonmedicated ophthalmic ointments
  • eye lubricant drops
  • warm/cold compress
48
Q

Tx of allergic conjunctivitis

A

antihistamine- vasoconstrictor (no more than 2 weeks)

49
Q

Corneal abrasion

A

Trauma to the cornea involving the epithelium w/o underlying infection or involvement of deeper layers

“scratch on the cornea”

50
Q

common causes of corneal abrasion

A
  • Trauma often from fingers/fingernails, chemicals, branches, etc.
  • More common in contact lens wearers
51
Q

Sx/complications of corneal abrasion

A
  • Decreased vision
  • Pain (extremely high concentration of nerves in the cornea)
  • Light sensitivity
  • Increased tearing
52
Q

Tx of corneal abrasion NOT d/t contacts

A

erythromycin ointment or trimethoprim-polymyxin

53
Q

Tx of corneal abrasion DUE to contacts

A

fluoroquinolones or aminoglycosides

54
Q

Hordeolum (stye)

A

Disorder of the eyelid. It is an acute focal infection (usually staphylococcal) involving either the glands of Zeis (external hordeola, or styes) or, less frequently, the meibomian glands (internal hordeola)

55
Q

Causes of hordeolum

A
  • Internal (Meibomian)
  • External (Zeis)
  • Staph
  • Side effect of Bortezomid/Velcade medication (tx. of Multiple Myeloma, Mantel Cell Lymphoma)
56
Q

Sx/complications of hordeolum

A

can progress to abscess or preseptal cellulitis

57
Q

Tx of horeolum

A
  • Warm compress, moist
  • How angry does it look?
  • How does the patient look head-to-toe? Immunosuppressed?
  • OTC pain relievers
  • Stye ointment
  • Refer to ophthalmologist if stye does not respond
  • Topical antibiotics to cover for Staph aureus
58
Q

hyphema

A

A pooling/collection of blood in the anterior chamber of the eye
-A bruise in the front of the inside of the eye

59
Q

cause of hyphema

A
  • Associated with trauma or post-surgically (eye surgery)

- Some people can get it without trauma- Diabetics, Inflammatory/Infectious diseases, Cancer-related (lesions, etc.)

60
Q

Sx/complications of hyphema

A

Sudden vision decrease, ”floaters,” and can cause pain/nausea and vomiting (sudden increase in pressure)

61
Q

Tx of hyphema

A
  • Should be sent to an eye care provider and evaluated for sickle cell if suspected
  • Refer if occurs with no hx of trauma, could mean patho cause
62
Q

Macular degeneration

A
  • Age related degeneration of the macula
  • Dry Macular Degeneration:
  • Slowly progressive
  • Occurs 90% of time
  • Wet Macular Degeneration:
  • Rapidly progressive
  • Occurs 10% of time
63
Q

cause of macular degeneration

A

Age-related- most commonly after 7th decade of life

64
Q

sx/complications of macular degeneration

A

Symptoms affect central vision:

  • Distorted or warped images
  • Missing areas in vision
  • Painless
  • Bilateral
  • Dry Macular Degeneration: Minimally affected vision
  • Wet Macular Degeneration: Can have drastic impact
65
Q

Tx for dry macular degeneration

A

-treat w/ eye vitamins (AREDS?)

66
Q

Tx for wet macular degeneration

A

-requires frequent injections Avastin to help seal off blood vessels

67
Q

nystagmus

A

rapid, involuntary eye movements

68
Q

causes of nystagmus

A

Nystagmus can be:

  • Congenital (asymptomatic) or Acquired (oscillopsia)
  • Pathologic or benign
  • Vestibular system (vertigo or abnormal input from vest. System), gaze evoke (eyes fatique, muscles tire) and optokinetics (Look at trees in driving car)
69
Q

Nystagmus can be a presenting symptom of what conditions?

A

Stroke, cancer, MS, drug intoxication and more

70
Q

how is nystagmus named?

A

based on direction of the “fast phase”

-e.g. up-beat (eyes drift down then rapidly move up

71
Q

amplitude/frequency of nystagmus

A

amplitude: size of movement
frequency: speed/interval

can be in any direction

72
Q

Tx of nystagmus

A

recognize and refer!

73
Q

optic neuritis

A

inflammation of the optic nerve

74
Q

cause of optic neuritis

A
  • most often d/t MS

- occasionally d/t viral infections/other causes

75
Q

Sx/complications of optic neuritis

A
  • Vision loss (central and color vision)
  • Pain with eye movements
  • +/- optic nerve swelling
  • Afferent pupillary defect (APD)
76
Q

What is the hallmark sx of optic neuritis?

A

pain w/ eye movement and vision loss

77
Q

Tx of optic neuritis

A
  1. establish diagnosis
  2. MRI of brain and orbit - looks for nerve enhancement and other lesions
  3. IV steroids speed visual recovery but ultimately doesn’t effect disease or recurrence
  4. Refer to neuro-ophthalmology or neurology!
78
Q

orbital cellulitis

A

inflammation of the eye tissue behind the orbital septum

79
Q

Cause of orbital cellulitis

A
  • Extension of acute or chronic sinusitis (90%)
  • Direct inoculation from skin trauma or surgery
  • Endogenous (Hematogenous spread from bacteremia)
80
Q

Sx/complications of orbital cellulitis

A
  • Fever
  • Pain
  • Visual acuity decreased
  • Proptosis
  • Motility deficit
  • Complications:
  • Vision loss/blindness
  • Cranial neuropathy
  • Cavernous sinus thrombosis
  • Brain abscess/meningitis
  • Death
81
Q

Dx/Tx of orbital cellulitis

A
  • Diagnosis
  • Abnormal eye exam: proptosis & conjunctival chemosis, motility restriction(s), sluggish pupil
  • Edema & erythema limited within the septum
  • Fever, elevated WBC, change in mental status
  • Well defined borders (redness)
82
Q

Papilledema

A

optic disc swelling caused by increased cranial pressure

83
Q

cause of papilledema

A
  • Space occupying lesions/tumors
  • Hydrocephalus
  • Pseudotumor cerebri (idiopathic intracranial HTN)
84
Q

Sx of papilledema

A

often asymptomatic, seen on exam

85
Q

Dx/Tx of papilledema

A

Correct dx often requires urgent referral.
*MRI to r/u space occupying lesions
*LP to msr CSF
Treat underlying cause – occasionally this needs specialty surgery

86
Q

Pterygium

A

thickening of conjunctiva in triangular appearance growing onto cornea - nasal side most common

87
Q

cause of pterygium

A

UV and wind exposure

88
Q

Sx/complications of pterygium

A

decreased vision, pain, or foreign body sensation

89
Q

Tx of pterygium

A

lubricate with artificial tears; send to an eye care specialist (surgical intervention sometimes needed); wraparound sunglasses

90
Q

retinal detachment

A

loss of vision d/t detachment of the retina

91
Q

cause of retinal detachment

A

starts w/ retinal tear, progresses to loss of central vision

92
Q

sx/complications of retinal detachment

A
  • Flashes of light
  • New floaters
  • Curtain/shade/veil in vision
  • More common in near-sighted pt
93
Q

Dx/Tx of retinal detachment

A

medical emergency

  • prompt surgery
  • only eye professionals can rule out
94
Q

retinal vascular occlusion

A

retinal artery or vein gets blocked

95
Q

cause of retinal vascular occlusion

A
  • Arterial occlusion: just like a stroke or embolism

- Venous occlusion is more variable: risk factors include HTN, diabetes, high cholesterol

96
Q

sx/complications of retinal vascular occlusion

A

-Sudden, painless vision loss.
- Central = total vision loss
- Branch = partial vision loss
-Fundoscope: “blood and thunder cotton wool spots”
Complications: if not corrected, leads to ischemia

97
Q

Dx/Tx of retinal vascular occlusion

A

Dx by ophthalmology.

Tx – reduce swelling. Avastin for venous occlusion to help seal off vessel

98
Q

retinopathy

A

small blood vessel damage causing vision loss

99
Q

cause of retinopathy

A
  • Diabetes, HTN, sickle cell, prematurity.
  • Often coexists with damage to other vital organs- kidneys, heart, brain, extremities.
  • Systemic causes have manifestations in multiple systems.
100
Q

sx/complications of retinopathy

A
  • Can be asymptomatic or mild blurring of vision until proliferative diagnosis.
  • Proliferative - So much ischemia, grow new blood vessels but they are fragile and break easily. When do, bleeding into eye and sudden vision loss.
101
Q

Dx/Tx of retinopathy

A
  • Proliferative diseases require laser treatment by ophthalmologist.
  • 1/3 of all diabetics have retinopathy – 10% have disease.
102
Q

strabismus

A

Misalignment of the two eyes (intermittent or constant)

103
Q

comitant strabismus

A

symmetric in all fields of gaze

104
Q

incomitant strabismus

A

can occur only in certain directions of gaze

105
Q

esotropia

A

turned in

106
Q

exotropia

A

turned out

107
Q

hypertropia

A

turned up

108
Q

hypotropia

A

turned down

109
Q

cause of incomitant strabismus

A

either d/t paralysis or restriction of a muscle

110
Q

cause of intermittent strabismus

A

tire, drunk, etc. when not impaired, brain can control eye

111
Q

cause of strabismus in children

A

issues w/ vision. rarely have double vision/neuro disease

112
Q

cause of strabismus in adults

A

sudden onset, almost always neurologic disease. ischemic nerve damage, MS, aneurysm, tumor, myasthenia gravis, thyroid eye disease, EOM entrapment

113
Q

Dx of incomitant strabismus

A

numb the eye and physically move it - if paralyzed, you can move it in any direction. if muscle is entrapped, it won’t move.

114
Q

When to refer for strabismus

A
  • child w/ crossed eye
  • amblyopia: loss of best vision in 1 eye due to lack of use
  • any adult w/ double vision or new strabismus

HEENOT (13 decks)

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