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”
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
3
Q
Sx of corneal ulcer
A
- decrease vision
- pain
- light sensitivity
- increased tearing
4
Q
Dx/Tx of corneal ulcer
A
Can’t dx cause by looking, must sent to specialist who will examine a scraping
5
Q
Dacryoadenitis
A
acute inflammation of the lacrimal gland
6
Q
cause of dacryoadenitis
A
- Inflammatory
- Malignancy
- Infection (less common) such as TB and MRSA
7
Q
Sx of dacryoadenitis
A
red, droopy upper eyelid
8
Q
Tx of dacryoadenitis
A
abx? (no info given)
9
Q
Ectropion
A
eyelid flips out
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
11
Q
Tx of ectropion
A
short-term temporizing:
-lubricating ointment
-moisture goggles at night
long-term management: surgery
12
Q
Entropion
A
eyelid flips in
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)
14
Q
Sx of entropion
A
lashes up against the eye when lid is flipped in
no Tx listed
15
Q
Foreign body
A
- foreign body on surface
- foreign body embedded in cornea
16
Q
cause of foreign body
A
-seen most often w/ grinding, chipping, hammering, sawing, plumbing, etc.
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
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
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
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???
21
Q
Acute glaucoma
A
EMERGENCY! -Sudden vision decrease -Fixed pupil -Pain -Redness -Nausea/vomiting \+/- Headache * If untreated, can be blind within 24 hours
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
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
24
Q
blepharitis
A
- Inflammation of the eyelid margin
- Dandruff-like scales form at the eyelashes base
- Not contagious
- Not visually-threatening
25
causes of blepharitis
- Bacterial (staph)
- Skin-related condition (rosacea)
- Allergies
- Lice / demodex
26
sx of blepharitis
- Pruritus and burning
- Soreness of the lid
- Skin changes (scaly & hyperemic)
- Photophobia
- Foreign body like sensation
- Dry eyes
27
general tx for blepharitis
- Warm compress
- Lid scrub (baby shampoo, selenium shampoo)
- Artificial tear replacement
- 90% will get better
28
topical abx tx for blepharitis
erythromycin, bacitracin azithromycin
29
Tx for blepharitis in refractory or severe cases
tetracyclines (doxy if caused by rosacea) and azithromycin
if demodex is cause: treat w/ tea tree oil and oral Ivermectin
30
Blowout Fx
With a blunt force trauma to the orbit, the force can cause the orbital floor to fx and “blowout”
31
Common causes of blowout fractures
- Assault (fist)
- MVC (dashboard)
- Falls (elderly)
- Sports injuries (balls / elbows)
- Occupational/Industrial accidents
32
What is the classic triad that often accompanies blowout fx
1. Enopthlalmos (recession of globe
2. Restrictive strabismus (inf. rectus m. entrapment)
3. Infraorbital V2 hypoesthesia
33
other sx/complications associated w/ blowout fx
- 30% have associated globe injury
| - in children can be a greenstick fx creating a "trap door"
34
Cataract
condition in which the lens become less opaque
35
causes of cataracts
- Aging
| - Made worse by: smoking, DM, increased UV exposure
36
sx/complications of cataracts
- Decreased overall vision
- Difficulty w/ bright lights
- Difficulty w/ vision in dimly lit situations
37
Tx of cataract
surgery - referral
38
chalazion
- Chronic granulomatous reaction
| - Meibomian glands get clogged and create bump in the lid
39
cause of chalazion
- clogging of meibomian gland
| - sterile
40
sx of chalazion
- Small lump on eyelid
- Do not confuse with:
* Stye
* Sebaceous cell carcinoma
41
Tx of chalazion
Start conservatively; will usually go away with hot compress and digital massage
42
conjunctivitis
inflammation or infection of the conjunctiva ("pink eye")
43
cause of conjunctivitis
- 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
44
sx/complications of conjunctivitis
- Decreased vision
- Discharge
- Increased redness of eye and/or eyelids with or w/o swelling
45
Tx of bacterial conjunctivitis in non contact wearers
1st line:
- erythromycin ointment
- trimethoprim-polymyxin
46
Tx of bacterial conjunctivitis for contact wearers
1st line:
| ocular fluoroquinolones
47
Tx of viral conjunctivitis
- antihistamine/decongestant drops
- nonmedicated ophthalmic ointments
- eye lubricant drops
- warm/cold compress
48
Tx of allergic conjunctivitis
antihistamine- vasoconstrictor (no more than 2 weeks)
49
Corneal abrasion
Trauma to the cornea involving the epithelium w/o underlying infection or involvement of deeper layers
“scratch on the cornea"
50
common causes of corneal abrasion
- Trauma often from fingers/fingernails, chemicals, branches, etc.
- More common in contact lens wearers
51
Sx/complications of corneal abrasion
- Decreased vision
- Pain (extremely high concentration of nerves in the cornea)
- Light sensitivity
- Increased tearing
52
Tx of corneal abrasion NOT d/t contacts
erythromycin ointment or trimethoprim-polymyxin
53
Tx of corneal abrasion DUE to contacts
fluoroquinolones or aminoglycosides
54
Hordeolum (stye)
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
Causes of hordeolum
- Internal (Meibomian)
- External (Zeis)
- Staph
- Side effect of Bortezomid/Velcade medication (tx. of Multiple Myeloma, Mantel Cell Lymphoma)
56
Sx/complications of hordeolum
can progress to abscess or preseptal cellulitis
57
Tx of horeolum
- 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
hyphema
A pooling/collection of blood in the anterior chamber of the eye
-A bruise in the front of the inside of the eye
59
cause of hyphema
- Associated with trauma or post-surgically (eye surgery)
| - Some people can get it without trauma- Diabetics, Inflammatory/Infectious diseases, Cancer-related (lesions, etc.)
60
Sx/complications of hyphema
Sudden vision decrease, ”floaters,” and can cause pain/nausea and vomiting (sudden increase in pressure)
61
Tx of hyphema
- 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
Macular degeneration
- 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
cause of macular degeneration
Age-related- most commonly after 7th decade of life
64
sx/complications of macular degeneration
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
Tx for dry macular degeneration
-treat w/ eye vitamins (AREDS?)
66
Tx for wet macular degeneration
-requires frequent injections Avastin to help seal off blood vessels
67
nystagmus
rapid, involuntary eye movements
68
causes of nystagmus
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
Nystagmus can be a presenting symptom of what conditions?
Stroke, cancer, MS, drug intoxication and more
70
how is nystagmus named?
based on direction of the "fast phase"
| -e.g. up-beat (eyes drift down then rapidly move up
71
amplitude/frequency of nystagmus
amplitude: size of movement
frequency: speed/interval
can be in any direction
72
Tx of nystagmus
recognize and refer!
73
optic neuritis
inflammation of the optic nerve
74
cause of optic neuritis
- most often d/t MS
| - occasionally d/t viral infections/other causes
75
Sx/complications of optic neuritis
- Vision loss (central and color vision)
- Pain with eye movements
- +/- optic nerve swelling
- Afferent pupillary defect (APD)
76
What is the hallmark sx of optic neuritis?
pain w/ eye movement and vision loss
77
Tx of optic neuritis
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
orbital cellulitis
inflammation of the eye tissue behind the orbital septum
79
Cause of orbital cellulitis
- Extension of acute or chronic sinusitis (90%)
- Direct inoculation from skin trauma or surgery
- Endogenous (Hematogenous spread from bacteremia)
80
Sx/complications of orbital cellulitis
- Fever
- Pain
- Visual acuity decreased
- Proptosis
- Motility deficit
* Complications:
- Vision loss/blindness
- Cranial neuropathy
- Cavernous sinus thrombosis
- Brain abscess/meningitis
- Death
81
Dx/Tx of orbital cellulitis
* 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
Papilledema
optic disc swelling caused by increased cranial pressure
83
cause of papilledema
- Space occupying lesions/tumors
- Hydrocephalus
- Pseudotumor cerebri (idiopathic intracranial HTN)
84
Sx of papilledema
often asymptomatic, seen on exam
85
Dx/Tx of papilledema
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
Pterygium
thickening of conjunctiva in triangular appearance growing onto cornea - nasal side most common
87
cause of pterygium
UV and wind exposure
88
Sx/complications of pterygium
decreased vision, pain, or foreign body sensation
89
Tx of pterygium
lubricate with artificial tears; send to an eye care specialist (surgical intervention sometimes needed); wraparound sunglasses
90
retinal detachment
loss of vision d/t detachment of the retina
91
cause of retinal detachment
starts w/ retinal tear, progresses to loss of central vision
92
sx/complications of retinal detachment
- Flashes of light
- New floaters
- Curtain/shade/veil in vision
- More common in near-sighted pt
93
Dx/Tx of retinal detachment
medical emergency
- prompt surgery
- only eye professionals can rule out
94
retinal vascular occlusion
retinal artery or vein gets blocked
95
cause of retinal vascular occlusion
- Arterial occlusion: just like a stroke or embolism
| - Venous occlusion is more variable: risk factors include HTN, diabetes, high cholesterol
96
sx/complications of retinal vascular occlusion
-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
Dx/Tx of retinal vascular occlusion
Dx by ophthalmology.
| Tx – reduce swelling. Avastin for venous occlusion to help seal off vessel
98
retinopathy
small blood vessel damage causing vision loss
99
cause of retinopathy
- 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
sx/complications of retinopathy
- 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
Dx/Tx of retinopathy
- Proliferative diseases require laser treatment by ophthalmologist.
- 1/3 of all diabetics have retinopathy – 10% have disease.
102
strabismus
Misalignment of the two eyes (intermittent or constant)
103
comitant strabismus
symmetric in all fields of gaze
104
incomitant strabismus
can occur only in certain directions of gaze
105
esotropia
turned in
106
exotropia
turned out
107
hypertropia
turned up
108
hypotropia
turned down
109
cause of incomitant strabismus
either d/t paralysis or restriction of a muscle
110
cause of intermittent strabismus
tire, drunk, etc. when not impaired, brain can control eye
111
cause of strabismus in children
issues w/ vision. rarely have double vision/neuro disease
112
cause of strabismus in adults
sudden onset, almost always neurologic disease. ischemic nerve damage, MS, aneurysm, tumor, myasthenia gravis, thyroid eye disease, EOM entrapment
113
Dx of incomitant strabismus
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
When to refer for strabismus
- 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
