Common Eye Disorders Flashcards
This is a globe-like structure that consists of a wall that encloses a fluid-filled cavity
globe of the eye or bulbus oculi
The ________ is the transparent, more curved anterior surface of the bulbus oculi
cornea
What is the anterior segment of the globe?
it is the front 1/3 of the eye which includes the cornea, iris, ciliary body and lens
What is the posterior segment of the globe?
it is the posterior 2/3 of the eye which includes the vitreous, retina, choroid and optic nerve
What are the two chambers in the anterior segment of the eye?
the anterior chamber which is a space between the posterior cornea (endothelium) and iris. The posterior chamber is an area behind the iris and in front of the vitreous.
both are filled with clear aqueous fluid.
Both chambers of the eye are filled with clear aqueous fluid. What is the purpose of it?
it nourishes the cornea and lens and maintains intraocular pressure
Hyphema vs Hypopyon
hyphema is blood in the AC due to trauma, sx and hypopyon is pus/white cell accumulation in the anterior chamber due to inflammation, infection
What are the 3 tunics of the eye
- sclera/cornea-fibrous
- choroid (uveal)- vascular, ciliary body forms aqueous humor/accommodation muscle
- retina- optic nerve/photoreceptors/macula
This type of condition can present with eyelid swelling, erythema (acute) or a well defined lid nodule (chronic). It is associated with blepharitis/acnea rosacea. What is the dx?
hordeolum/chalazion
What is the rx for hordeolum/chalazion?
warm/hot compressess with digital massage. Btracin or Emycin or antibiotic ggts
External hordeolum (stye)
inflammatory lesion of the anterior eyelid due to obstruction of glands of Moll and Zeis. TENDER
Chalazion (internal hordeolum)
localized inflammation of the posterior eyelid due to obstruction of the meibomian gland. NON TENDER
A patient presents with burning, FBS, itching, tearing, and lid erythema. You also notice that this patient has crusty, red, thickened lid margins with prominent blood vessels or inspissated oil glands and conjunctival injection. What is the dx and how would you explain it to the patient?
blepharitis. It is a common, chronic, recurrent inflammation of the eyelid margin. It is not contagious and the symptoms flux through days and weeks
What is blepharitis associated with?
dry eye, rosacea, chalazia
What is the treatment for blepharitis?
lid scrubs, hot compress, topical emycin, azithromycin gel drops, oral doxycycline
What is entropion?
inward turning of the eyelid margin
What symptoms is entropion associated with?
ocular irritation, FBS, tearing, red eye, superficial punctate keratitis (SPK), abrasians, scarring can result from lashes contacting globe (sclera/cornea)
What is ectropion?
outward turning of the eyelid margin
What symptoms is ectropion associated with?
tearing, eye or eyelid irritation or may be asymptomatic, superior punctate keratitis (SPK) inferiorly from corneal exposure
You want to treat ectropion and entropion if there is __________ involvement. What are the tx options?
corneal.
lubricating agents, antibiotic ointments, bandage contact lens, epilate any inward turning lashes touching the cornea (trichiasis), definitive tx may require lid surgery with oculoplastics
The lacrimal system serves as a conduit for tears to flow from the ___________ to the _______. What does it consist of?
external eye, nasal cavity.
puncta, canaliculi, lacrimal sac, nasolacrimial duct
A patient presents with inflammation of the lacrimal sac that is associated with pain, and epiphora. What is the dx and how is this treated?
dacryocystitis
treated with oral antibiotics (cephalexin), hot compress, topical eye drops alone are not adequate.
What are the symptoms associated with acute glaucoma?
severe ocular pain, redness, blurred vision, halos around lights, headache, N/V
What is the normal range for IOP?
10-21 mmHg
What is the IOP for someone with angle closure?
> 50
What are the high risk groups for acute angle closure glaucoma?
shallow anterior chamber
hyperopia (farsightedness)
elderly/thickening (cataract with age)
family hx of angle closure
asian/inuits
What is the treatment for acute glaucoma?
lower IOP with meds (topical IOP gtts and oral acetazolamide) - immediate but temp
peripheral iridotomy (PI)
What is anterior uveititis?
swelling/inflammation of the uvea (middle layer of the eye). There is pain, red eye, photophobia
What is posterior uveitis?
choroid/retina. There are floaters, visual disturbance
T/F uveitis can lead to permanent vision loss
True
Keratitic precipitates, cells and flare in AC, synechiae, ciliary flush, virtitis, retiinal hemes are all associated with which condition?
uveitis
What is the common etiology of anterior uveitis?
HLA-B27 positive autoimmune disease (ankylosing spondylitis, JRA, Crohn’s disease, ulcerative colitis, reiter’s syndrome)
What are the etiologies associated with posterior uveitis?
sarcoidosis, lyme, toxoplasmosis
What is the treatment for uveitis?
cycloplegic, topical steroid, duzerol tid
A patient presents with unilateral red eye, pain, FBS, tearing and photophobia. This patient has a history of having previous episodes of this condition. For this condition, you decide to do corneal staining. What is the dx and how would you treat it?
herpes simplex keratitis
trifluridine drops or ganciclovir gel
oral antivirals: acyclovir or valcyclovir
What do you want to avoid when treating a patient for herpes simplex keratitis?
topical steroids
What is conjunctivits?
it is inflammation or infection of the outer membrane (conjunctiva) of the eyeball and inner eyelid
What is the role of the conjunctiva?
it is a mucus membrane that covers the front of the eye and lines the inside of the eyelids
A patient presents with hyperemia, and purulent discharge. What type of conjunctivitis is this?
bacterial
A patient presents with hyperemia, serous discharge, preauricular lymphadenopathy, URI and is contagious. What type of conjunctivitis is this?
viral
A patient presents with hyperemia, a stringy discharge and hay fever. What type of conjunctivitis is this?
allergic
What is the treatment for bacterial conjunctivitis?
- topical antibiotics (polytrin, ofloxacin, polysporin ointment, fluroquinolones),
- cool compress
What is the treatment for viral conjunctivitis?
cool compress,
topical lubrication,
caused by adenovirus
precautions to prevent
spread (handwashing)
What is the treatment for allergic conjunctivitis?
topical antihistamines/mast cell stabilizers for acute and chronic allergies,
oral antihistamines,
cool compress, artificial tears
What is subconjunctival hemorrhage?
an accumulation of blood under the conjunctiva. It has a bright red appearance initially and there are no symptoms
What is the etiology of subconjunctival hemorrhage?
valsalva: coughing, sneezing, rubbing, idiopathic, blood thinners (aspiring, warfarin), blood clotting disorder (rarely)
What is the treatment for subconjunctival hemorrhage?
it will clear spontaneously in 1-3 weeks. no treatment unless there is trauma history or it is recurrent
What is pinguecula?
it is a yellow-white, flat or slightly raised conjunctival lesion NOT INVOLVING THE CORNEA
What is pterygium?
it is a wedge shaped fold of fibrovascular tissue arising from the interpalpebral conjunctiva and EXTENDING ON THE CORNEA
What are the symptoms for pinguecula/pterygium?
irritation,redness, or may be asymptomatic. there are cosmesis concerns
What is the treatment for pinguecula/pterygium?
protect the eyes from sun, dust, wind, UVc sunglasses/safety goggles
Lubricate with artificial tear drops to reduce irritation
if inflammed can use NSAIDs or topical antihistamines/mast cell stabilizers
surgical removal if severe
What are the symptoms of Keratoconjunctivitis Sicca (dry eye)
burning, dryness, tearing
FBS/redness
worsened by wind, smoke, low humidity, prolonged reading/computer use
usually bilateral
common/chronic
discomfort often out of proportion due to clinical signs
What are the treatment options for dry eye?
artificial tears
AT gel drops or ointment
Smoking cessation
Humidifier
Restasis/Xiidra/Cequa drops - doesnt work well
Punctal plugs
Fish oil/flax
What will a dry eye stain reveal?
spots on the cornea caused by loss of epithelial cells due to dryness
A patient presents with pain, photophobia, tearing and redness. This patient has a history of scratching their eyes. You realize that this type of epithelial defect stains. What is the dx?
Corneal abrasion
A patient presents with pain, photophobia, tearing and redness. This patient has a history of contact lens use. With staining, there is a white lesion. What is the dx?
corneal ulcer
What are the treatment options for corneal abrasion and a corneal ulcer?
fluroquinolone drops
cycloplegic agent if iritis
NEVER USE TOPICAL ANESTHETICS
for corneal ulcer discard and d/c CL use
What is the most common cause of contact lens related corneal infection?
pseudomonas aeruginosa
What are danger signs?
- reduced visual acuity
-associated with serious ocular disease
-not conjunctivitis - ciliary flush
-redness maximal near cornea
-not conjunctivitis
If visual acuity is acutely reduced, it is not __________ and need to refer patient.
conjunctivitis
Fluorescin shows ____________ defect but more pathology may be present
epithelial
What type of medication do you NEVER want to prescribe and use only for exam. What can it cause?
topical anesthetics and it can cause severe corneal ulceration
What are the risks with topical steroids?
they make herpes simplex and fungal infections worse. they can cause cataracts and glaucoma. (they make eye pressure go up)
What is the cause of legal blindness in the US? What are the risk factors?
macular degeneration (ARMD) Risk factors are advanced age, heredity, drusen, tobacco.
What is macular degeneration manifested by?
drusen
retinal pigment epithelial atrophy
subretinal neovascular membrane
loss of central vision
What is dry macular degeneration?
slowly progressive
bilateral
drusen, pigment layer atrophy
peripheral vision intact
may evolve to wet type
How do you manage the dry type macular degeneration?
no cure
vitamins (AREDS) slows the progression by 25%. AREDS2 formulation is preferred bc it does not contain beta-carotene which can increase risk of lung CA in smokers
Low vision aids
Monitor for wet type: AMSLER GRID
What is wet type macular degeneration?
choroidal neovascular membrane (CN5) develops
hemorrhage, edema
metamorphopsia, sudden decrease of vision
fibrosis, repeat episodes
macular scar
What are management options for wet type macular degeneration?
F1 angiography/OCT imaging
Anti-VEGF injections
PDT or LASER obliteration of CNV
Monitor for recurrence and other eye
______________ images the layers within the retina to aid in early detection of retinal conditions.
optical coherence tomography (OCT)
What is the leading cause of irreversible blindness in the world?
glaucoma
What is glaucoma?
optic neuropathy. traditionally its attributed to intraocular pressure that is too high for a given optic nerve and results in damage to the optic nerve over time. Damage to the optic nerve results in visual field loss.
What is primary open angle glaucoma?
-most pts asymptomatic (silent thief of vision)
-sx and noticeable visual field defects occur late in the disease.
-early detection is critical if blindness is to be prevented
What are the risk factors for glaucoma?
-age
-family hx
-trauma/sx/steroids
-DM, CV disease
What are the characteristics of Glaucomatous ONH?
enlarged cup, c/d ratio >0.65 (average is 0.3)
hemorrhage within 1dd of ONH
thinning of neuro-retinal rim esp sup./inf. (doesnt obey the ISNT rule)
Asymmetric cupping between patients eyes
Inf rim should be thickest, sup should be thinnest
In primary open angle glaucoma, there is progressive loss of ______________ which leads to ___________________ typically at the superior and inferior poles resulting in a ________________
retinal ganglion cells
enlargement of the cup
vertically oval cup or notching
Where is our normal “blind spot” located? What is it caused by?
in the temporal field of vision. It is caused by the absence of retina where the optic nerve exits the eye
What is the treatment for glaucoma?
meds: IOP lowering eye drops, prostaglandins (main tx)
laser trabeculoplasty (SLT, ALT)
filtration surgery (trabeculectomy)
MIGS (minimally-invasive glaucoma surgeries)
What occurs during retinal detachment?
vitreous separates from the anterior retinal (floaters)
some strands remain attached to the retina (flashes)
vitreous movement tears retina
fluid seeps behind retina
What do you want to do in the event that a patient has a new onset of flashes/floaters?
refer the patient for dilated fundus exam (DFE) to determine is RD is present.
Untreated RD can lead to partial or total loss of retinal function (blindness)
How is retinal detachment managed?
once macula is off, prognosis for good vision decreases.
surgical repair with laser, cryopexy, buckle or pneumatic retinopexy
A patient complains of having many floaters, sudden flashes of light in their peripheral vision and a shadow blocking part of their field of vision. This recently occurred after being hit in the eye while playing baseball (a trauma) what is the dx?
retinal detachment
What are the risk factors associated with retinal detachment?
high myopia, trauma, previous ocular surgery, age
What is cataracts?
an opacity (clouding) of normally clear lens
lens anatomy: capsule, cortex, nucleus
What are the risk factors associated with cataracts?
age, UV radiation, diabetes, trauma, congenital, uveitis, steroid
What are the symptoms associated with cataracts?
glare, especially in night driving
blurred vision
cortical- peripheral spicules early, vision good initially
nuclear- shift toward myopia color shift toward yellow
subcapsular- early trouble reading
How is cataracts managed?
sx if the vision loss or sx of glare interfere with job or lifestyle. Implants also available
______________ is common after cataract surgery. It is a secondary clouding of posterior capsule causing decrease in vision/glare.
posterior capsule opacification. The tx is YAG laster capsulotomy (does not have to be repeated)
__________ is a leading cause of blindness.
Diabetic retinopathy (DR)
What are the risk factors associated with diabetic retinopathy?
duration of diabetes
control of blood sugar
insulin dependency
HTN
anemia
What is type I diabetic retinopathy?
after 5 years, 25% have diabetic retinopathy (DR)
After 15 years, 80% have diabetic retinopathy
What is type II diabetic retinopathy?
exact onset of DR may not be known, incidence of DR somewhat less
What is nonproliferative diabetic retinopathy?
capillaries leak, are occluded.
red spots (hemorrhages, microaneurysms)
hard exudates in circinate configuration
cotton wool spots
macular edema
venous engorgement, beading
What is proliferative diabetic retinopathy?
increased retinal ischemia
neovascularization, initially at optic disc
fibrous tissue proliferation
vitreous hemorrhage
traction retinal detachment
What is the treatment for diabetic retinopathy
yearly dilated eye examination minimally
control of glucose, HTN, other systemic diseases
Anti VEGF injections or laster treatment of focal leakage areas
pan retinal photocoagulation (PRP)
vitrectomy
What are the complications associated with diabetic retinopathy?
neovascular glaucoma
traction retinal detachment
vitreous hemorrhage
cataract
What are changes that hypertension causes?
-arterial narrowing may be general,segmental
-flame (splinter) hemorrhages
-cotton wool spots
-hard exudates, macular star
-edema of the disc
What are arteriosclerotic changes?
widening of arterial stripe
A/V nicking
copper colored arteries
silver wire arteries
What is amaurosis fugax?
it is transient loss of vision in one eye (monocular)
no pain
lasts 1-10 minutes
total or altitudinal vision loss (like a window shade)
vision returns to normal
What is amaurosis fugax caused by?
temporary lack of blood flow to the retina from emboli in central retinal artery
often no emboli visible on fundus exam
What is amaurosis fugax most commonly caused by?
vascular or heart disease
Amaurosis fugax is considered a form of ____________
TIA.
asap referral to stroke center or ER
MRI, urgent carotid and cardiac studies and neurology consultation
What is the leading cause of visual impairment worldwide?
uncorrected refractive errors
_____________ is a problem with focusing light accurately onto the retina due to the shape of the eye.
refractive errors
What are the different types of refractive errors?
Emmetropia
Myopia (nearsighted)
Hyperopia (farsighted)
Astigmatism(nonspherical curvature)
Presbyopia (loss of focusing ability of lens)
What is an astigmatism?
the surface of the cornea has a stronger curveature in one meridian than in the other meridian
What is presbyopia?
loss of focusing ability of lens. It is a normal result of aging. a form of farsightedness, occurs when the lens of the eye becomes thicker and less flexible. The lens cannot adjust and the image is focused beyond the retina
A ________ is the test to determine Rx for glasses
refraction
