Disorders of Eyes and Eye lids

Question 0

DO of the lids and lacrimal apparatus

Hordeolum

Answer 0

common staphylococcal abscess - localized red swollen acutely tender area on the upper or lower lid. Internal is a meibomian gland abscess that usually points onto conjunctiva surface of lid. external is usually smaller and on the margin. warm compress, antbx, i/d, internal can lead to cellulitis.

Question 1

Refractive errors

Answer 1

reduced visual acuity - use of pinhole to overcome r error
contact lense - risk of fungal/bacterial infection -hand washing
sx - removal of crystaline lense, w or w/out insertion of intraocular lense. Intrastromal corneal ring segments INTACS, conductive keraplasty CK.

Question 2

DO of lids and lacrimal apparatus

Chalazion

Answer 2

granulomatous inflammation of meibomian glad that may follow an hordeolum. Hard nontender swelling of the upper or lower lid with redness and swelling of the adjacent conjuntiva. if large - incision and curettage, but corticosteroid inj may also be effective.

Question 3

DO of lids and lacrimal apparatus

Blepharitis

Answer 3

common chronic BILATERAL inflam d/o of the lid margins.
Anterior - eyelid skin, lashes, and glands - ulcerative, staphylococci or seborrheic r/t scalp, brows, ears.
Posterior -lid margins are red w/telangiectasias and meibomian glands are inflamed.
common cause of recurrent conjunctivitis

Question 4

d/o of lids and lacrimal apparatus

Common cause of recurrent conjunctivitis

Answer 4

blepharitis
anterior - tx with baby shampoo, remove scales, use of antbx bacitracin or erythromycin for acute cases
mild posterior - expression and or antbx if inflammed conjunctiva and cornea .. tetracycline 250mg bid, doxy 100mg qd, minocycline 50-100 qd or erythromycin 250 tid. possible st corticosteroids - should be restricted to short courses of tx when in combination.

Question 5

entropion

Answer 5

turning in of eyelids usually lower - from degen of lid fascia
sx indicated if lashes rub on cornea, botulinum inj for temp correction.

Question 6

ectropion

Answer 6

outward turning of the lower lid.

sx for excessive tearing, exposure keratitis, or cosmetic problem

Question 7

tumors of the eye

Answer 7

basal cell is the most mallignant
squamous cell, meibomian gland carcinoma, malignant melinoma
sx, or excision of small leision with histopathologic exam - Mohs technique - ensures complete excision decreasing recurrence risk.

Question 8

dacryocystitis

Answer 8

infection of the lacrimal sac r/t congenital or obstructed nasolacrimal system. acute or chronic, infants and over age 40, usually unilateral. staphylococcus, streptococci, Candida albicans in chronic.
pain, swelling, tenderness, and redness in tear sac area, can have purulent d/c. tx with sx, or antibx, dacryocystorhinostomy rare.

Question 9

conjunctivitis

Answer 9

most common eye disease - acute or chronic, viral or bacterial
moderate d/c, no impact on vision, mild pain, clear cornea, pupil size normal, perrla unchanged, iop unchanged, bacterial - can have purulent d/c- use topicals, viral -cold compresses

Question 10

gonococcal conjunctivitis

Answer 10

opthamologic emergency r/t corneal involvment can lead to perforation. dx confirmed by stained smear and culture d/c. 1g single dose of ceftriaxone, topicals can be added erythromycin bacitracin.. investigate for stds.

Question 11

differentiate between: conjunctivitis, uveitis, acute angle closure glaucoma, corneal trauma/infection

Answer 11

incidence: conjunctivitis uveitis AAGG CT/I
d/c: mod to copius no no watery/purulent
vision: no O blurred V blurred O blurred
Pain: mild mod severe mod to sev
conj. inj. diffuse, follicles circumcorneal same same
cornea: clear clear cloudy depends
pup size: norm small dilated norm to small
resp to lt: norm poor none norm
ICP norm norm high norm
smear: cause org. no org. no org. if infection

Question 12

chlamydial keratoconjunctivitis - trachoma

Answer 12

most common infectious cause of blindness WW.
Manifests as bilat tarsal conjunctiva leads to entropion and trichiasis in adulthood, with secondary central scarring
Immunologic tests, polymerase chain reaction on conjunctival samples to confirm. start on azithromycin , sx for eyelid deformity.

Question 13

Inclusion conjunctivitis

Answer 13

common cause of genital tract disease in adults.
starts with acute redness, discharge, and irritation.
eye findings consist of follicular conjunctivitis with mild keratitis.
non-tender preauricular lymph node can often be palpated.
immunologic tests or polymerase chain reaction
TX with azithromycin

Question 14

Dry Eyes - Keratoconjunctivitis Sicca

Answer 14

Common in older women
hypo fx of lacrimal glands - loss of aqueous component of tears - r/t aging, hereditary, systemic d/o or drugs. Environmental evaporation.
A deficient = Mucin deficiency
pt c/o dryness, redness, feel like foreign body in ey
Schirmer test- measures rate of production of aqueous coponent
tx - nacl drops, sx,

Question 15

allergic eye disease - atopic

Answer 15

Allergic conjuctivitis, Vernal Keratoconjunctivitis, atopic keratoconjunctivitis: tx with H1 receptors, or non steroid receptors anti inflam.ketorolac…

Question 16

Pinguecula

Answer 16

yellow elevated conjunctival nodule

more common on nasal side in area of palperable fissure - often bilat, tx: artificial tears, nsaids gtts

Question 17

Pterygium

Answer 17

fleshy triangular encroachment of the conjunctiva onto the nasal side of the cornea - often bilat.. environmental exposures..
tx: artificial tears, nsaids gtts

Question 18

corneal ulcer

Answer 18

r/t infection, bacteria, virus. pt c/o pain photophobia, tearing, reduced vision. eye is red with circumcorneal injection w/purulent or watery d/c.

Question 19

when to refer

Answer 19

any pt with acute painful red eye and corneal abnormality = emergently to opthamologist

Question 20

herpes simplex keratitis - when to refer

Answer 20

any pt with hx of HSK and acute red eye should be emergently referred.

Question 21

corticosteroid caution

Answer 21

topical corticosteroids should be prescribed only with opthalmic supervision

Question 22

Herpes Zoster Opthalmicus

Answer 22

opthalmic division of trigeminal nerve
presents with mailaise, fever, h/a, periorbital burning.Vesicular rash. involvment of tip of nose or lid margin predicts involvement with eye. Signs = conjunctivitis, keratitis, episcleritis, anterior uveitis.
Refer urgently to opthamologist.

Question 23

acute angle closure glaucoma

Answer 23

older age group, farsighted, rapid onset pain, profound vision loss with halo around lights.
red eye,cloudy cornea, dilated pupil, hard eye on palpation. Can be precipitated by pupil dilation - sitting in dark theater.

Question 24

clinical findings for acute angle closure glaucoma

Answer 24

pts seek care for pain in eye with blurred vision. nausea and abd pain may occur. eye is red, cornea cloudy, pupil mod dilated and nonreactive to light. iop is usually over 50, making eye hard

Question 25

differential dx for acute angle closed glaucoma

Answer 25

conjunctivitis - mild pain, but no vision change

acute uveitis and corneal d/o’s

Question 26

tx of acute angle closure glaucoma

Answer 26

reduce iop - 1 iv dose of 500mg acetazolamide, then 250mg po qid. if acetazolimide noneffective, iv urea or mannitol 1-2g/kg. then pilocarpine gtts q15min, then qid… refer to opthamologist emergently

Question 27

chronic glaucoma

Answer 27

no symptoms early stages
insidious progressive bilateral loss of peripheral vision = tunnel vision.
pathologic cupping of optic disks
iop elevated

Question 28

normal range of occular pressure?

Answer 28

10-21mm Hg

Question 29

what is the cup ratio suggestive of chronic glaucoma

Answer 29

cup-disk ratio greater than .5, or .2 or more asymmetry between eyes

Question 30

tx for chronic glaucoma

Answer 30

prostaglandin analogs: bimatoprost .03%, latanoprost, tafluprost, travoprost - each used once daily at night and unoprostone bid. common first line therapy.
topical beta-adrenergic blocking agents -timolol, carteolol, levobunolol, metipranolol - can be used in combo. contraindicated for reactive airway d/o, or hf. betaxolol safer but less impact on iop
apraclonidine -alpha agonist - to postpone sx, not longterm