Clinical Notes Flashcards
Saccadic movements
- Rapid, jerky movements that bring the image of a new object onto the fovea.
- They also allow us to quickly scan points on an image to capture salient features (like a new face).
Smooth pursuit eye movement
eye movements keep a moving image
centered on the fovea. (tracking, “keeping your eye on the ball”)
Vestibulo-ocular gaze
keeps an image steady on the fovea during head movements.
Vergence
keeps the image on the fovea
when the viewed object is moved nearer or farther away.
medial longitudinal fasciculus
It is involved in coordinating eye and head movements by yoking the motor nuclei of CN III, IV and VI, integrating movements directed by the frontal eye field (gaze centers) and vestibular information coming from the vestibulocochlear nerve (CN VIII).
itching eyes suggest…
allergic conjunctivitis
bilateral eye symptomes suggest…
allergic response
unilateral eye symptomes suggest…
viruses and bacteria, usually start in one eye then move to second eye a couple days later
Eye pain, photophobia, blurred vision suggests what…
not typically associated with conjunctivitis
Viral Conjunctivitis
- Commonly occurs in community epidemics
- Acutely red eye, watery discharge and foreign-body sensation
- May also have URI
- Most common virus – adenovirus
- Less common but more severe – herpes simples and zoster
Hyperacute Bacterial
- Severe, sight-threatening infection
- Abrupt onset, copious yellow-green discharge
- Redness, tender, lid swelling, adenopathy
- Caused by N. gonorrhoeae and N. meningitidis
- Presents in neonates and sexually active young adults
Acute Bacterial
- Burning, tearing, mucopurulent or purulent discharge
- Eyelids matted together on awakening
- Slower onset and much less severe than hyperacute bacterial conjunctivitis
Chronic bacterial
- Most commonly caused by staph species
- Eyelid symptoms and findings including swelling, debris, eyelash loss
Ocular Chlamydial Infections
- Trachoma – serotypes A-C (most common in US)
- Inclusion conjunctivitis – serotypes D-K (vision threatening) newborn and adults
Trachoma
Chronic keratoconjunctivitis
- Most common cause of ocular morbidity and preventable blindness in the world.
- Rural Africa, Asia and the Middle East
- Rare in North America but seen in immigrants
Inclusion Conjunctivitis
- Sexually transmitted disease of newborns and adults
- Infants exposed to chlamydia from mother’s infected cervix
- Develop tearing, conjunctival discharge and eyelid swelling 5-12 days after birth
Adults
- Presents in young, sexually active persons between 18-30
Treatment of Conjunctivitis
- Hyperacute – ceftriaxone IM plus topical eye antiobiotic plus saline irrigation
- Acute bacterial – topical antibiotic
- Chronic bacterial – warm compresses to eyelids and scrubbing of eyelids, topical antibiotic
- Chlamydia – oral tetracycline, doxycycline or erythromycin for two to three weeks
A 6-year-old male is brought to your office by his father. He has a three-day history of a red right eye and a one-day history of slight left eye redness. His kindergarten class has several students with the same illness. He has a mild cold and notes some clear drainage of the eye. You recommend:
cold compresses and supportive care
most likely viral etiology… adenovirus?
A 24-year-old male presents with a one-day history of right eye redness, eyelid swelling and a copious yellow-green drainage. The most infectious etiology causing these symptoms is:
N. gonorrhoeae
A 70 year old female presents with a one year history of intermittent right eye crusting and eyelid swelling. She has no pain in the eye and no recent colds. In your treatment, you want to make sure you cover:
staph epi
