Diseases Flashcards by Kellie Wheeler

Chronic low-grade inflammation of the eyelids; can wax and wane; associated with increased risk of chalazion and hordeolum

Blepharitis (meibomianitis)

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Sxs: Foreign body sensation, burning, dry eye, erythema of eye lids, irregular lid margins, flaking and crustiness, variable acuity, itching, tearing

Blepharitis (meibomianitis)

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Sty; acute, localized lesion; infection of eyelid

sxs: painful and tender to touch

Hordeolum

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Chronic, granulomatous blockage of meibomian glands

Sxs: Raised and non-tender (non infectious)

Chalazion

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Nasolacrimal duct; obstruction/inflammation, lesion under medial canthus area

Dacrocystitis

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Sxs: Raised/tender lacrimal sac or duct; possible purulent dishcarge through puncta

Dacrocystitis

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Turning out of eyelids usually due to aging

Sxs: Epiphora (excessive watering), grittiness, dryness

Ectropion

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Eyelashes irritating the eye

Trichiasis

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Sxs: Itching, tearing, glossy injection of conjunctiva (low-grade erythema) with follicles, papillae (bumps), and watery d/c

Allergic conjunctivitis

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Sxs: Red eyes of varying intensity, mucopurulent d/c, often worse in AM

Bacterial conjunctivitis

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Most commonly adenovirus, very contagious

Sxs: Mild to very red eye, watery d/c

Viral conjunctivitis

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What should you look for in PE when diagnosing viral conjunctivitis

Check pre-auricular node

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Very common, yellow-white raised lesions on conjunctiva (usually at 3 and 9 o’clock), do not affect the cornea (near limbus)
Sxs: Redness, dryness, foreign body sensation

Pinguecula

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Wing-shaped fibrovascular growth arising from the conjunctiva and extending onto the cornea; lesion can be highly vascularized

Pterygium

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Sxs: High vascularization may cause dryness, foreign body sensation, can induce an increase in astigmatism

Pterygium

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Physical drooping of the lid; minimal/possible superior visual defects

Ptosis (horner’s syndrome with mitosis and anhidrosis)

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Ulcerations on cornea, causes cornea to be less sensitive (check corneal reflex); linear, branching epithelial ulcerations with terminal bulbs

Viral Keratitis caused by HSV

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What are the two types of keratitis

Viral and bacterial

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Rapid progression; corneal destruction may be complete in 24-48 hours.

Sxs: Corneal ulceration, blurred vision, acute red eye, pain, photophobia, discharge

Bacterial keratitis

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Sxs: Red eye, pain, watery discharge, reduced acuity, usually unilateral

Viral keratitis

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“Dry eye”

Cornea disorder

Keratitis (keratoconjunctivitis sicca) corneal ulcers

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Sxs: Gritty , Foreign body sensation, Burning, Variable acuity, Paradoxically excess tearing (because your tears are crap)

Keratitis (keratoconjunctivitis sicca)

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Caused by something hitting the eye

Sxs: Mild to extreme discomfort, Photophobia, Tearing, Discomfort with blinking

Corneal abrasion

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Something stuck in eye; history is critical

Sxs: Scratchy, painful

Corneal foreign body

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From bacterial infection | (same sxs and txt as bacterial keratitis, but has white ulcer); Ask abt contact lens

Corneal ulcer

Sxs: Blurred vision, Red eye, Pain, Photophobia, Discharge

Corneal ulcer

Serious! MEDICAL EMERGENCY. Infection posterior to orbital septum Extensive swelling and erythema of the eylids and surrounding tissue; Very painful

Orbital cellulitis

Sxs: Very painful, Blurred vision, HA, Diplopia, EOM restriction, Possibly proptosis (bulging)

Orbital cellulitis

Acute, rapid rise in IOP due to the trabecular meshwork being occluded by the iris (known as a pupillary block) OCULAR EMERGENCY!

Closed angle acute glaucoma

Sxs: Very intense sx (acute); IOP > 50; Very inflamed eye, Mid-dilated and sluggish pupil (fixed), Possibly steamy cornea, Pt c/o reduced acuity, HA of varying degree, N/V

Closed angle acute glaucoma

Damage to the optic nerve causing VF loss/defects; Generally associated with eleavated IOPs (>22); Be cautious: many have IOPs

Open angle chronic glaucoma

Sxs: Optic nerve damage, VF loss, "splinter"/"Drance" hemorrhages on the optic disc/nerve, most often asymptomatic, increased "cupping" @ optic nerve center

Open angle chronic glaucoma

How to assess for open-angle glaucoma

Assessment w/ a slit-lamp Look at chamber angle Tonomotry: IOP measurement Evaluate optic nerve through dilated pupils (use a stereoscopic view) Pachymetry: measures central corneal thickness Threshold visual fields - automated Analyze retinal nerve fibers

Blood in anterior chamber clogs the trabecular meshwork | Usually due to trauma

Hyphema

Any insult to the interior or exterior of the eye creates an immune rxn by this tract.; The damage done by inc. WBCs is worse than any benefit; Caused by trauma, systemic infection, or idiopathic.

Anterior uveitis

Linked to: Spondylitis, IBD, Reactive Arthritis, Juvenile RA, Syphilis, Lyme Disease

Anterior uveitis

Sxs: Floaters, Blurred vision, Pain, Redness, Photophobia , Excessive tearing, Decreased vision, Occasionally HA, nausea Injection (ciliary or limbal flush); Redness around limbus; Cells and flare (protein) in anterior chamber; Keratic precipitation in posterior cornea; Possible miotic pupil

Anterior uveitis

Less common Linked to: Choroiditis, Retinitis, Toxoplasmosis* (most common cause)

Posterior uveitis

Sxs: Blurred vision; NO pain, redness, photophobia; Cells in vitreous (white spots seen), Possible retinal lesions

Posterior uveitis

Can cause a secondary glaucoma AKA "inflammatory (low-grade) iritis" and "Posner-Schlossman Syndrome IOP >40 due to cells in the anterior chamber clogging the trabecular meshwork

Iritis

Sxs: Intermittent episodes of blurred vision | Mantains an open angle

Iritis

RELATIVE OCULAR EMERGENCY, Peeling away of the retina from the retinal pigment epithelium (RPE), which attaches from the choroid Three types: Regmatogenous Due to break or tear Fluid occupies space between the RPE and retina Exudative, No break, Just fluid Tractional, Fibrocellular bands in the vitreous contract and detach the retina, Seen in very advanced diabetics

Retinal detachment

Sxs: Flashes of light, Increase in floaters, Possible curtain or shadows in periphery, Central vision might be affected *Confrontation fields are important Pigmented cells in vitreous, Vitreous hemorrhage, Elevation of retina seen w/ ophthalmoscopy, Usually need to dilate

Retinal detachment

Blockage most often due to embolism Hollenhorst plaque (cholesterol) often seen at bifurcations of a blood vessel & looks yellow Also consider Giant Cell/Temporal Arteritis; collagen vascular disorder

Central Retinal Artery Occulsion (CRAO)

Sxs: One eye, Painless vision loss, Episodes of transient vision loss; Overall whitening of posterior pole, Classic cherry red spot in macula, Probably APD (Marcus Gunn pupil), Narrowed retinal arterioles, Boxcarring of the blood column

Central retinal artery occlusion (CRAO)

Most often caused by atherosclerosis of the adjacent central retinal artery - results in compression of the CRV near the lamina Ischemic: More serious; hemorrhages; cotton wool spots; higher risk of neovascularization Non-ischemic: Less hemorrhaging; no pupillary problem; better acuity

Central Retinal Vein Occulusion (CRVO)

One eye, Painless loss of vision, Variable acuity loss ; Extensive 4 quadrants of hemorrhaging, Dilated vessels, Tortuous (wavy) veins, Cotton wool spots (ischemia), Macula edema, Neovascularization (later in ds process)

Central Retinal Vein Occulusion CRVO

Often caused by hypertension and arteriosclerosis | c/c Hypertensive Retinopathy

Branch Retinal Vein Occlusion (BRVO)

Sxs: One eye, Peripheral blind spots, Variable acuity loss More superficial hemes in retina; Can include cotton wool spots, vessel toruosity, macula edema; Sometimes neovascularization

Branch Retinal Vein Occlusion (BRVO)

Damage to the retinal blood vessels of varying degree; Leading cause of blindness in working age Americans; can cause macular edema *MUST recommend annual eye exams! Damage can begin w/o sxs

Diabetic retinopathy

What are the two types of diabetic retinopathy?

Non-proliferative; proliferative (more severe)

Sxs: Can be asymptomatic; Blurred vision; Red flag: if change within a few months period, Shadows, Missing spots, Reduced night vision, Cotton Wool spots (ischemia)

Diabetic retinopathy

Sxs: Enlarged and blocked blood vessels: microaneurysms | Bleeding (retinal hemorrhages) and fluid leakage

Non-proliferative diabetic retinopathy

Sxs: Neovascularization (new vessels) - fragile and can hemorrhage; Can lead to vitreous hemorrhage

Proliferative diabetic retinopathy

Sxs: Bilateral, Often asymptomatic, Occasionally blurred vision, Arteriolar narrowing, A/V nicking at crossings, Arterioles look sclerotic - "copper/silver" wiring, Associated flame shaped hemes with cotton wool spots

Hypertensive retinopathy

Dry, Non-exudative, No hemorrhages, Chronic: Vision loss is painless and gradual

Dry macular degeneration

Wet, Exudative, AKA "Neovascular", Acute

Wet macular degeneration

Sxs: Gradual loss of central vision, Metamorphopsia (wave in vision), Dx with Amsler Grid, Can be asymptomatic Macular drusen (yellow deposits, deep in retina), Pigment clumping, RPE atrophy

Dry macular degeneration

Sxs: Subretinal fluid (most often blood), Due to choroidal neovascularization - fragile vessels, Vision loss and distortion, Occurs quickly, Can have central or para-central blind spots

Wet macular degeneration

Any opacity of the lens; The lens is about 65% water and 35% proteins, The proteins are arranged in a precise way, but over time the proteins may clump together and cloud some of the lens Some correlation with free radical formation Could be caused by sun exposure, aging, and unbalanced diets

Cataracts

Yellow of brown discolor of central lens - blurs distance vision

Cataracts (nuclear sclerosis)

Radial spoke-like opacities - causes glare

Cataracts (Cortical)

Plaque-like opacities on posterior lens - often in younger pts

Posterior subscapular cataracts

Causes of cataracts (8)

``` Age Steroids: systemic and topical UV insult Trauma Diabetes Medications Congenital Rubella, Marfans, Downs syndrome ```

Sxs: Slowly progressive loss of vision or blurring, Increase in glare, esp. at night, Halos around lights, Not a clear red reflex

Cataracts

``` Blood pooling in conjunctiva Can be due to trauma or idiopathic Investigate systemic causes if recurrent (Warfarin, etc. use) *CLARE - contact lens acute red eye ```

Subconjunctival hemmorhage

Redness of varying intensity; For CLARE: Photosensitivity

Subconjunctival hemmorhage

Strong relationship with MS; One eye, Afferent pupillary defect (APD) (Marcus Gunn), Reduced vision (temporary), Poor color vision, Central scotoma/sometimes inferior field defect, Possible pain on eye movement

Optic neuritis

Involuntary movement of the eyes; Could be a symptom of underlying eye/medical problem; Due to: congenital, illness, accident, unknown cause

Nystagmus

Sxs: Reduced visual acuity; Dec. depth perception, Balance/coordination problems

Nystagmus

Increased intracranial pressure | Swollen optic nerve

Pappiledema

Dermatomal pain, paresthesias, numbness and vesicular ruptures around eye Hutchinson sign

Viral keratitis with HZV

Hutchinson sign is associated with which cranial nerve?

5th