Diseases Flashcards
Chronic low-grade inflammation of the eyelids; can wax and wane; associated with increased risk of chalazion and hordeolum
Blepharitis (meibomianitis)
Sxs: Foreign body sensation, burning, dry eye, erythema of eye lids, irregular lid margins, flaking and crustiness, variable acuity, itching, tearing
Blepharitis (meibomianitis)
Sty; acute, localized lesion; infection of eyelid
sxs: painful and tender to touch
Hordeolum
Chronic, granulomatous blockage of meibomian glands
Sxs: Raised and non-tender (non infectious)
Chalazion
Nasolacrimal duct; obstruction/inflammation, lesion under medial canthus area
Dacrocystitis
Sxs: Raised/tender lacrimal sac or duct; possible purulent dishcarge through puncta
Dacrocystitis
Turning out of eyelids usually due to aging
Sxs: Epiphora (excessive watering), grittiness, dryness
Ectropion
Eyelashes irritating the eye
Trichiasis
Sxs: Itching, tearing, glossy injection of conjunctiva (low-grade erythema) with follicles, papillae (bumps), and watery d/c
Allergic conjunctivitis
Sxs: Red eyes of varying intensity, mucopurulent d/c, often worse in AM
Bacterial conjunctivitis
Most commonly adenovirus, very contagious
Sxs: Mild to very red eye, watery d/c
Viral conjunctivitis
What should you look for in PE when diagnosing viral conjunctivitis
Check pre-auricular node
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
Wing-shaped fibrovascular growth arising from the conjunctiva and extending onto the cornea; lesion can be highly vascularized
Pterygium
Sxs: High vascularization may cause dryness, foreign body sensation, can induce an increase in astigmatism
Pterygium
Physical drooping of the lid; minimal/possible superior visual defects
Ptosis (horner’s syndrome with mitosis and anhidrosis)
Ulcerations on cornea, causes cornea to be less sensitive (check corneal reflex); linear, branching epithelial ulcerations with terminal bulbs
Viral Keratitis caused by HSV
What are the two types of keratitis
Viral and bacterial
Rapid progression; corneal destruction may be complete in 24-48 hours.
Sxs: Corneal ulceration, blurred vision, acute red eye, pain, photophobia, discharge
Bacterial keratitis
Sxs: Red eye, pain, watery discharge, reduced acuity, usually unilateral
Viral keratitis
“Dry eye”
Cornea disorder
Keratitis (keratoconjunctivitis sicca) corneal ulcers
Sxs: Gritty , Foreign body sensation, Burning, Variable acuity, Paradoxically excess tearing (because your tears are crap)
Keratitis (keratoconjunctivitis sicca)
Caused by something hitting the eye
Sxs: Mild to extreme discomfort, Photophobia, Tearing, Discomfort with blinking
Corneal abrasion
Something stuck in eye; history is critical
Sxs: Scratchy, painful
Corneal foreign body
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
