Conditions Flashcards
what is considered lid and adnexal disorders?
Hordeolum/Chalazion
blepharitis
contact dermatitis
herpers zoster opthalmicus (HZO)
preseptal and orbital cellulitis
dacryocystitis
inflammatory nodules in the eyelid caused by blockage of sebaceous glands +/- infection
hordeolum/chalazion
treatment for hordeolum/chalazion?
warm compresses +/- topical antibiotic drops/ ointment
typically self-limited
chronic inflammation of eyelid margin- often caused by staph?
blepharitis
delayed hypersensitivity to agents that come in contact with skin (eye drops, cosmetics)
contact dermatitits
reactivation of varicella zoster virus in V1 dermatomal distribution
Herpes zoster opthalmicus
what is a sign you should look out for with herpes zoster?
Hutchinson’s sign- rash on tip of the nose
treatment for contact dermatitis?
stop the offending agent
treatment for herpes zoster?
oral acyclovir or valacyclovir- rarely IV
what is the difference between preseptal cellulitis vs orbital cellulitis?
preseptal celluitis is an infection of the eylids and he soft tissue ANTERIOR to the orbital septum (pts have normal motility)
Orbital Cellulitis is an infection posterior to orbital septum- may begin as preseptal and is known as a medical emergency impaired ocular motility
what are symptoms of preseptal cellulitis?
eyelid edema and erythema
normal motility, pupils, visual acuity
what is a treatment of preseptal cellulitis?
systemic antibiotics, admission to hospital if sever case or young patient
what are symptoms of orbital cellulitis?
Lid edema and erythema
impaired ocular motility, proptosis (eye bulging), chemosis (eye irritation),
decreased vision, RAPD
what is a treatment of orbital cellulitis?
admission to hospital
emergent opthalmology consult
blood cultures
CT orbits,
IV antibiotics, +/- abscess drainage
what are some complications of orbital cellulitis?
optic nerve damage
meningitis
cavernous sinus thrombosis
what syndrome is most common in infants (delayed opening of nasolacrimal passage)
dacryocystitis
when does dacyocystitis appear in adults?
occurs when nasal passage is blocked by trauma, neoplasm, or inflammation
what is the treatment for dacryocystitis?
NLD massage in infants +/- antibiotics
antibiotics in adults
what disorders or conjunctival and scleral disorders?
conjunctivitis
subconjunctival hemorrhage (hyposphagma)
scleritis/ episcleritits
pinguecula and pterygia
what causes conjunctivitis? which is the most common?
bacterial, viral, allergic, chemical, autoimmune
*viral most common
what are signs and symptoms of bacterial conjunctivitis?
chemosis (eye irritation)
redness
pus
what is the treatment of bacterial conjunctivitis?
swab/culture
broad antibiotic drops (polytrim, ocuflox, ciloxan
how do you treat bacterial conjunctivitis that is caused by gonococcal infection?
systemic antibiotics and possible hospitalization
* this requires immediate referral
what are the signs and symptoms of viral conjunctivitis?
watery or mucoid discharge
often spreads to the other eye
upper respiratory infection
enlarged lymph nodes
what is viral conjunctivitis caused by? How should it be treated?
commonly caused by adenovirus, enterovirus
treatment is self-limited (should resolve in 7-10 days)
but you can use artificial tears, cool compress
what are symptoms of allergic conjunctivitis?
itching, chemosis, tearing
what are some treatment options of allergic conjunctivitis
Topical antihistamines or oral agent if there is a respiratory component
what are some disorders autoimmune conjunctivitis is associated with?
Grave’s connective tissue disease, vasculitides, sarcoidosis
what are symptoms of autoimmune conjunctivitis?
diffuse redness, orbitopathy
which eye disorder is often a result of sneezing, nose blowing, eye rubbing. Its also associated with use of antiplatelet agents and anticoagulation?
Subconjunctival hemorrhage
signs and symptoms of subconjunctival hemorrahage?
mild foreign body sensation but no vision changes
if there is a recurrent subconjunctival hemorrhage what should you evaluate for?
blood dyscrasias, hypertension
what are the signs and symptoms of episcleritis?
focal tenderness, redness, swelling, mild pain
what are the signs and symptoms of scleritis? what is scleritis usually associated with?
deep aching pain; redness, +/- scleral thinning
associated with systemic connective tisse disease (RA, Lupus)
vision threatening
what treatment is available for scleritis and episcleritis?
oral or topical NSAIDs for episcleritis
systemic immunosuppressants for scleritis
what is pinguecula and pterygia? what are the differences between the two? what are these disorders assocaited with
dysplatic conjunctiva
its called pterygium when it grows onto cornea)
associated with excess sun and wind exposue
signs and symptoms of pinguecula and pterygia?
sudden eye pain and redness when inflamed
what are treatments for pinguecula and pterygia?
artificial tears for comfort
+/- surgical excision of pterygium if visually significant
what are disorders of the cornea?
corneal abrasion
corneal ulcer
herpes keratitis
chemical injuries
dry eye
what are signs and symptoms of corneal abrasion?
severe pain
redness
tearing
light sensitivity
+/- blurred vision
what are diagnostic evaluations of corneal abrasion?
pain improves with proparacaine
epithelial defect stains with fluorescein
what treatments are available for corneal abrasion?
time
antibiotic ointment for comfort and prophylaxis
signs and symptoms of corneal foreign bodies?
pain
tearing
redness
photophobia
foreign body that stains with fluorescein
treatment of corneal foreign body?
removal with wet cotton tip
30g needle or burr
antibiotic drops for prophylaxis
if high speed injury refer for dilated exam
what disorder is a serious infection of the cornea? Could be a history of FB, trauma etc.?
corneal ulcer
what are signs and symptoms of corneal ulcer?
sever pain
redness
tearing
light sensitivity
blurred vision
white corneal infiltrate that stains with fluorescein
treatment of corneal ulcer?
scrapings and culture
intensive medical management with drops
+/- surgical intervention
what disorder is a ocular infection with herpes simplex virus involving corneal epithelium?
herpetic keratitis
how is herpetic keratitis diagnosed? where can HSV cause disease
classically dendritic lesion with fluorescein
*can cause disease anywhere in the eye
what is treatment for herpetic keratitis?
oral acyclovir
For chemical injuries to the eye (ocular emergency) which is worse, acid vs alkali?
alkali: more damaging, lipophilic and penetrates tissue rapidly
acid: protein coagulation, of corneal epithelium, more superficial injury
Treatment for chemical injuries?
flush eye immediately
check pH (eye should be 7)
evaluate for surface damage and presence of limbal ischemia
antibiotic drops, tetanus, pain relief
what is preferred to be seen on evaluation of a chemical injury?
red eye is preferred
whitening around cornea is concerning for ischemia= stem cell deficiency
which disorder is the common cause if eye irritation, redness.
often seen in post-menopausal women, systemic conditions such a sjogren’s patients with blepharitis
Dry eyes
what are symptoms of dry eyes?
dry, scratchy, irritated, tearing +/- blurred vision
punctate corneal staining
treatment for dry eyes?
artificial tears ointment
disorders of the anterior chamber
anterior uveitis
acute angle closure glaucoma
endophtalmitis
inflammation of the iris and ciliary body
associated with collage vascular disease (RA, Lupus, HLA B-27)
anterior uveitis
signs and symptoms of anterior uveitis?
eye pain
photophobia
blurred vision
perlimibal flush +/- poorly reactive or irregular pupil, AC cell/flare
*no improvement with proparacaine eye drops
treatment for anterior uveitis?
topical steroids and cycloplegia (pharmacological paralysis of ciliary muscle)
sudden increase in intraocular pressure caused by obstruction of drainage system of the eye (ocular emergency)
acute angle closure glaucoma
signs and symptoms of acute angle closure glaucoma
deep pressure/pain or headache
halos, vision loss, nausea or vomiting
fixed-mid dilated pupil, narrow AC, corneal edema (blunted light reflex) elevated IOP (>30) hazy cornea
treatment of acute angle closure glaucoma?
pressure lowering eye drop +/- diamox
laser iridotomy
infection within the eye that can be both exogenous and endogenous? (ocular emergency)
endophthalmitis
entry wound after trauma or surgery (greatest risk within 2 weeks of surgery)
exogenous endophthalmitis
spread of infection from another body source (rare)
endogenous endophthalmitis
which eye disorders are true emergencies?
gonococcal conjunctivitis
chemical injury
orbital cellulitis
acute angle closure
endophtalmitis
which eye disorders require same day referral?
anterior uveitis
corneal ulcer
corneal foreign body
episcleritis/scleritis
which eye disorders can be referred for 1-2 days
preseptal cellulitis
corneal abrasion
herpes zoster opthalmicus
herpetic keratitis
which eye disorders can be referred if there no improvement?
chalazion/hordeolum
blepharitis,
dry eye
dacryocystitis
viral or bac. conjuctivitis
subconj. hemorrhage
pinguecula/pterygium
Often caused by blunt trauma; blood in the anterior chamber; vision variable by size. Intraocular pressure may be elevated
hyphema
treatment of hyphema?
monitor intraocular pressure
limit activity- strict bedrest, upright/head of bed elevated, eye shield
may have history of recent eye surgery/trauma, severe systemic infection, severe corneal ulcer; Finding of white blood cells in the anterior chamber
Hypopyon
May see flashing lights, floaters (typically few)
may have decreased visual acuity
posterior vitreous detachment
what are signs and symptoms of retinal tear or detachment?
flashes, lots of floaters, +/- shade or curtain in peripheral vision. may have visual field loss, possible poor red reflex may be seen on ultrasound. Visual acuity may be normal
what are signs and symptoms of retinal artery or vein occlusion?
sudden painless vision loss in middle age patient with hypertension, diabetes, dyslipidemia; or a young patient with hyper-coagulability
decreased vision or field loss
treatment of retinal artery or vein occlusion?
may need stroke workup including carotid ultrasound and echo for arterial occlusion
transient, or permanent vision loss, headache, scalp tenderness, jaw claudication, hip/shoulder pain typically in patients over 60 y/o
Temporal arteritis
what are signs and symptoms of acute thyroid eye disease?
eyelid swelling, conjunctival chemosis
symptoms include: pain, double vision, vision loss, constricted visual fields, loss of color vision
signs and symptoms of chronic thyroid eye disease?
upper and lower lid retraction, proptosis, poor extra-ocular movements
exposure and dryness
double vision
how does thyroid eye disease affect the orbit? muscles? lids?
Orbit: reduced volume, orbital fat expansion
muscles: hypertrophy of extra-ocular muscle, cellular infiltration
lids: retractor muscles hypertrophy similar to rectus muscles, lids get pulled back
treatment for thyroid eye disease?
lubricate cornea
immunosuppression: steroids, riuxin, radiation
surgery: on orbit, muscles or lids
smoking cessation
what are symptoms of cataracts?
typically patients describe progressively blurry vision (happens over the years)
also complain of halos, glare
tend to have worse symptoms at night (increased difficulty driving at night)
what type of cataract is associated with the center of the lens progressively clouding with age. Can be due to UV, diet, systemic disease (i.e, diabetes) free radicals
myopic shift can occur as a consequence
nuclear sclerosis
type of cataract that has clouding of the posterior aspect of the lens; usually small and thin but greatly affects vision. Associated with diabetes, steroid usage. Can develop quickly
posterior subcapsular
type of cataract that changes in cortex, usually spoke like, rare affect vision unless in visual axis; may cause more glare
cortical
other types of cataracts
traumatic, cogenital
what is the treatment for cataracts?
cataract extraction
*perform if functionally significant (vision <20/40)
glare, halos
benefits outweigh risks
what is the leading cause of irreversible blindness in developed countries?
age-related macular degeneration
what is the most common type of AMD?
Dry or non-neovascular
what is the pathophysiology of dry or non-neovascular?
retinal pigment epithelium cells in macula accumulate debris overtime, yellow deposits formation (drusen formation) loss of RPE leads to atrophy of photoreceptors
what is the pathophysiology of wet or neovascular AMD?
Neovascular membranes form under the retina
new vessels are leaky and fluid accumulates in the retina (macular edema)
what are symptoms of AMD?
Blurry vision centrally; peripheral vision spared vision may be distorted (amsler grid)
how can you diagnose AMD?
-Fluorescein angiography
(leaky vessels identified) wet vs dry
-optical coherence tomography (OCT)
cross section of macula
identify fluid under retina
what is the treatment for Wet AMD?
Anti-VEGF agents
monthly-ish injections into the eye
what is the actual definition of glaucoma? what is a common misconception?
death of retinal ganglion cells
Common misconception about glaucoma is that a high IOP means glaucoma- it does not
what is the pathophysiology behind glaucoma?
it is unknown - but damage to cell bodies or axons primarily
also ocular hypertension and low tension glaucoma
clinical diagnosis for glaucoma?
increased IOP and cup to disc ratio
decreased visual fields, decreased retinal fiber nerve thickness on ocular CT
vision loss from macular edema, detachment, vitreous hemorrhage? how can you treat this disease>
diabetic retinopathy
can be treated with focal laser, and panretinal photocoagulation
difference between acute narrow angle closure glaucoma and chronic open angle glacuoma
Acute narrow angle has sudden onset of severe, unilateral ocular pain. Vision changes include halos around lights & loss of peripheral vision
Chronic open angle is a slow, progressive painless bilateral peripheral vision loss and is usually asymptomatic until late in the disease course
a patient with acute narrow angle closure glaucoma presents to clinic, what symptoms would you most likely see?
Conjunctival erythema, cloudy “steamy” cornea, mid-dilated fixed pupil (reacts poorly to light)
eyes hard on palpation
A patient with chronic open angle glaucoma presents to clinic, what findings would you most likely see?
usually asymptomatic until late in the disease course but you would see cupping of optic discs, increased cup to disc ratio, notching of the disc rim
often referred to as lazy eye
decreased vision that results from abnormal visual development in infancy and early childhood
it can happen even when there is no problem with the structure of the eye
Amblyopia
double vision due to crossed eye is suppressed by the brain in young children
strabismic ambylopia
what are two types of refractive amblyopia? what is the definition of both?
anisometropia: Significantly different refractive errors between the two eyes
Isometropia: too near sighted or too far sighted equally
opacities of ocular media (cataract, corneal scar) ptosis
Form deprivation amblyopia or occlusive amblyopia
what types of strabismus are congenital/infantile?
infantile esotropia
accommodative esotropia
intermittent exotropia
what type of strabismus is paralytic? what cranial nerve can be affected?
cranial nerve palsy
(cranial nerve III, IV, VI)
what type of strabismus is restrictive?
Thyroid eye disease (commonly seen in grave’s disease)
Large angle tropia’s are obvious to detect- how do you detect small angle tropia?
Cover uncover test
how do you elicit a phoria (latent strabismus)
alternate cross cover test (breaks fusion)
What are signs and symptoms of Essential infantile esotropia?
Angle large and stable
nystagmus in some cases
normal refraction for age
presents within the first 6 months
where do you commonly see accommodative Esotropia? what are the signs?
eye crossing inward that is caused by the focusing efforts of the eyes as they try to see clearly.
onset: 18 months-4years
typically in farsighted (hyperopic) patients
what should you know about intermittent exotropia?
Onset age: 10months - 4yrs
worse with fatigue/sickness/ at the end of the day
usually alternating (amblyopia uncommon)
can get worse and become constant exotropia if not treated properly
what is the Worth 4-dot test able to detect?
can detect fusion, diplopia (double vision) or suppression, and functional vision loss/compliant
what is the Hirschberg reflex test used for? What would you expect the corneal light reflex to be for normal? exotropia? esotropia? What does this test not detect?
The Hirschberg test is used to judge the position of corneal light reflexes
Symmetrically central= normal
nasal reflex= exotropia
temporal reflex= esotropia
downward reflex= hypertropia
upward reflex=
DOES NOT DETECT angle tropia or phorias
what does the bruckner reflex assess for?
leukocoria, stabismus, anisometropia and anisocoria
*it also shows unequal reflexes in the presence of strabismus, refractive errors or suspected amblyopia
what does the prism cover test measure?
total deviation
what are treatments for amblyopia?
correction for optical erros
patching
atropine penalization
What are treatments for strabismus?
refractive error correction (especially in accommodative esotropia due to hyperopia/farsightedness)
prism
eye muscle surgery
