CM: Chronic Vision Loss & Trauma Flashcards
Which red eye conditions are vision threatening?
corneal infections (keratitis) scleritis hyphema iritis acute glaucoma orbital cellulitis chemical injury (alkali urgent, acid next day) should all be recognized and referred to opthalmologist
diffuse, erythematous swelling of lids
lids tender to touch, may be swollen shut
cellulitis
What is the difference b/w pre-septal/pre-orbital and orbital cellulitis?
pre-septal/pre-orbital - visual acuity, pupils, motility normal, no proptosis
orbital - opposite, motility may be painful, APD
When should conjunctivitis be referred?
vision impaired, inf suspected, pt fails to respond to Rx after 3-4 days
Conjuncitivitis discharge: purulent clear stringy, white mucus What caused it?
bacteria
virus (look for preauricular lymphadenopathy)
allergies
When should neonatal conjunctivitis consult an opthalmologist?
if pseudomonas suspected - can damage cornea
gonococcal conjunctivitis needs urgent treatment
mild, mucopurulent conjunctivitis in a neonate
often accompanied by pneumonitis and otitis media
chlamydia
dry eyes, redness, burning, foreign body sensation, reflex tearing, lack of luster
keratoconjunctivitis sicca
pain, photophobia, blurred vision
corneal disorder symptoms
When is a fluorescein exam appropriate?
aids in detection of irregularities of corneal surface - when abrasion suspected
redness, tearing, foreign body sensation, blurred vision, photophobia
corneal abrasion
discrete corneal opacity (infiltrate) on exam
bacterial keratitis - don’t use steroids!
blood in anterior chamber from blunt trauma, red eye, decreased vision, pain, hx of blunt trauma
hyphema
circumcorneal redness, pain, photophobia, decreased vision, miotic pupil
iritis - cataract and glaucoma can be complications
severe ocular pain, frontal headache, N/V, blurred vision with halos around lights
eye usually red, pupil mid dilated and oval, cornea cloudy
acute glaucoma
What are risk factors for macular degeneration?
advanced age
fair skin
family hx of ARMD
smoking and CV dz
What can minimize effects of ARMD?
stop smoking, control CV dz, diet high in fruits and vegetables lowers risk, antioxidants, anti-VEGF
What are the risk factors for glaucoma?
elevated IOP African or Hispanic heritage advanced age family hx HTN, diabetes, myopia
How is glaucoma managed?
meds: beta blockers, adrenergic agonists, cholinergic agonists, prostaglandin analogs, carbonic anhydrase inhibitors
surgery: laser or filtration, cyclodestructive of ciliary body, insert drainage device
When is surgery for cataracts indicated?
significant visual impairment, daily activities curtailed
no current medical Rx
What is the epidemiology of ocular trauma?
accounts for 40% of all monocular blindness
80% are male, avg age = 30
lower socioeconomic status more likely
occupational injuries most common, domestic increasing
blunt objects are leading cause
motor vehicle accidents and sports related increasing
What do the following terms regarding ocular trauma mean?
a. eyewall
b. closed globe injury
c. open globe injury
d. rupture
e. laceration
f. perforating injury
g. penetrating injury
h. intraocular foreign body
i. contusion
j. lamellar laceration
a. sclera and cornea
b. eyewall does not have full thickness wound
c. eyewall has full thickness wound
d. full thickness wound of eye wall caused by blunt object
e. full thickness wound of eye wall caused by sharp object
f. 2 full thickness: entrance and exit - of eyewall, usually sharp object or missile
g. 1 full thickness laceration of eyewall, usually sharp object
h. causes entrance laceration
i. closed globe injury from blunt object
j. closed globe injury usually from sharp object
redness concentrated to palpebral area
conjunctivitis
conjunctivitis with copious purulent discharge
suspect n. gonorrhoeae
mild conjunctival reaction and lid swelling but no significant discharge in neonate
chemical conjunctivitis (from silver nitrate)
swollen lids, purulent exudate, beefy red conjunctiva, conjunctival edema in infant
neonatal gonococcal conjunctivitis - refer to ophthalmologist
What are episcleritis and scleritis?
inflammatory redness and tenderness
episcleritis - minimal pain and superficial vessels over cornea involved
scleritis - more dangerous - moderate to severe pain and red eye (with purplish hue), typically signs of systemic dz
optic disc cupping
open angle glaucoma
What is a cataract?
opacity in crystalline lens of eye
