Clinical Notes

Question 1

Saccadic movements

Answer 1

• 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).

Question 2

Smooth pursuit eye movement

Answer 2

eye movements keep a moving image
centered on the fovea. (tracking, “keeping your eye on the ball”)

Question 3

Vestibulo-ocular gaze

Answer 3

keeps an image steady on the fovea during head movements.

Question 4

Vergence

Answer 4

keeps the image on the fovea
when the viewed object is moved nearer or farther away.

Question 5

medial longitudinal fasciculus

Answer 5

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).

Question 6

itching eyes suggest…

Answer 6

allergic conjunctivitis

Question 7

bilateral eye symptomes suggest…

Answer 7

allergic response

Question 8

unilateral eye symptomes suggest…

Answer 8

viruses and bacteria, usually start in one eye then move to second eye a couple days later

Question 9

Eye pain, photophobia, blurred vision suggests what…

Answer 9

not typically associated with conjunctivitis

Question 10

Viral Conjunctivitis

Answer 10

• 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

Question 11

Hyperacute Bacterial

Answer 11

• 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

Question 12

Acute Bacterial

Answer 12

• Burning, tearing, mucopurulent or purulent discharge
• Eyelids matted together on awakening
• Slower onset and much less severe than hyperacute bacterial conjunctivitis

Question 13

Chronic bacterial

Answer 13

• Most commonly caused by staph species
• Eyelid symptoms and findings including swelling, debris, eyelash loss

Question 14

Ocular Chlamydial Infections

Answer 14

• Trachoma – serotypes A-C (most common in US)
• Inclusion conjunctivitis – serotypes D-K (vision threatening) newborn and adults

Question 15

Trachoma

Answer 15

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

Question 16

Inclusion Conjunctivitis

Answer 16

• 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

Question 17

Treatment of Conjunctivitis

Answer 17

• 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

Question 18

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:

Answer 18

cold compresses and supportive care

most likely viral etiology… adenovirus?

Question 19

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:

Answer 19

N. gonorrhoeae

Question 20

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:

Answer 20

staph epi