EENT #2 Flashcards
What is the MC type of macular degeneration?
Dry (progressive, over decades)
True or False: Wet macular degeneration is not as common as dry, but is more aggressive?
True. It progresses within months
Symptoms of macular degeneration
- Bilateral, progressive central vision loss including detailed and colored vision
- Metamorphopsia (straight lines appear bent)
- Micropsia (objects seem smaller in the affected eye)
What is seen on funduscopic examination for dry macular degeneration?
Drusen bodies: small round yellow white spots on the outer retina
What is seen on funduscopic exam for wet (exudative) macular degeneration?
-New abnormal vessels that can cause retinal hemorrhages and scarring
What are three ways to diagnose and monitor macular degeneration?
- Funduscopy
- Fluorescein angiography
- Amsler grid
Management of dry macular degeneration
- Zinc and antioxidant vitamins (C&E) may slow progression
- Amsler grid to monitor stability
Management of wet macular degeneration
- Intravitreal VEGF Inhibitors (Bevacizumab, Ranibizumab, Aflibercept)
- laser photocoagulation
What is the MCC of new, permanent vision loss in 20-74 year olds
Diabetic retinopathy
What are the two types of diabetic retinopathy?
Nonproliferative and proliferative
What are some exam findings of a patient with nonproliferative (background) Diabetic retinopathy?
- Microaneurysms
- Cotton wool spots (soft, white grey fluffy spots)
- Hard exudates: yellow spots with sharp margins that circinate (circular)
- Blot and dot hemorrhages (bleeding into deep retinal layer)
- Flame shaped hemorrhages
What are some exam findings of a patient with proliferative diabetic retinopathy?
-Neovascularization: growth of new abnormal blood vessels that can lead to vitreous hemorrhage
Treatment for nonproliferation diabetic retinopathy?
Strict glucose control, laser treatment
Treatment for proliferative diabetic retinopathy
- VEGF inhibitors intravitreal injection
- Laser photocoagulation treatment
- Strict glucose control
How often are diabetic eye exams performed to detect retinopathy?
Annually
What is hypertensive retinopathy?
Damage to retinal blood vessels from longstanding high blood pressure
Explain the difference in severity in a patient with copper wiring and silver wiring with hypertensive retinopathy?
Copper wiring: moderate narrowing
Silver wiring: severe narrowing
What is seen with severe (Grade IV) hypertensive retinopathy?
- Copper wiring
- AV nicking
- Flame hemorrhages
- Cotton wool spots
- Papilledema
What are some risk factors for a retinal detachment
- Myopia (nearsightedness)
- previous cataract surgery
- Advancing age
- Trauma
MC type of retinal detachment
Rhegmatogenous: full thickness tear causes retinal inner sensory layer to detach from choroid plexus
What type of retinal detachment is a result of proliferative diabetic retinopathy, sickle cell disease, or trauma?
Tractional: adhesions separate the retina from its base
Symptoms of a retinal detachment
- Photopsia (flashing lights)
- Floaters
- Progressive unilateral peripheral vision loss
- Shadow or curtain/veil coming down in periphery
- Followed by central vision loss
- No ocular pain
What diagnostic study is done to detect a retinal detachment?
Funduscopy
What is seen on funduscopy with a retinal detachment?
Shafer’s Sign: clumping of brown pigment vitreous cells in the anterior vitreous humor resembling “tobacco dust”
A retinal detachment is an ophthalmologic emergency. What recommendations should you give the patient?
-Keep patient supine with head turned toward side of detachment
What is ophthalmia neonatorum?
Neonatal Conjunctivitis
If the neonatal conjunctivitis occurs on Day 1, what is the most likely cause?
Chemical conjunctivitis due to silver nitrate
-Artificial tears may be helpful once it occurs
If the neonatal conjunctivitis occurs on Days 2-5, what is the most likely cause?
Gonococcal most likely cause
-Purulent conjunctivitis with exudate and swelling of the eyelids
If gonococcal in nature, what is the treatment and prophylaxis for neonatal conjunctivitis?
- Prophylaxis: Topical erythromycin to prevent infection
- Treatment: IM or IV Ceftriaxone
If the neonatal conjunctivitis occurs on Days 5-7, what is the most likely cause?
Chlamydia Trachomatis may occur up to 23 days after birth
What is the treatment for chlamydia neonatal conjunctivitis?
Oral erythromycin
Standard neonatal prophylaxis against gonococcal conjunctivitis given immediately after birth is
Erythromycin ointment 0.5%
True or False: Neonatal ocular prophylaxis is NOT effective in preventing neonatal chlamydial conjunctivitis
True
What is seen on fluorescein staining with a corneal abrasion?
Ice rink/linear abrasions
evert eyelid to look for it
What is the management for ocular foreign body and corneal abrasions?
- Antibiotic drops
- -Non contact lens wearers: Erythromycin ointment, Polymyxin-Trimethoprim, Sulfacetamide
- -Contact lens wearers: Pseudomonal coverage (Topical Ciprofloxacin or Ofloxacin)
What if a rust ring is present with a corneal abrasion
Remove at 24 hours using rotating burr by an ophthalmologist
What contraindication must be remembered if the patient is a contact lens wearer and Pseudomonas is suspected?
Do not patch!
True or False: Antibiotics containing corticosteroids are not used in corneal abrasions or foreign bodies because they can prolong healing and open the patient up to superinfection?
True
MCC of bacterial conjunctivitis in adults
Staph Aureus
What are other causes of bacterial conjunctivitis?
Strep Pneumo H. Influenzae M. Catarrhalis N. Gonorrhoeae Chlamydia Trachomatis
Symptoms of bacterial conjunctivitis
- Purulent discharge
- Lid crusting (eye stuck shut in the morning)
- Conjunctival erythema with no ciliary injection (limbal flush)
- No significant visual changes
What diagnostic should be done to determine what bacteria is at play with the conjunctivitis?
Culture and gram stain of the discharge
If the patient is not a contact lens wearer, what is the treatment for bacterial conjunctivitis?
-Erythromycin ointment, Trimethoprim-Polymyxin B, Fluoroquinlones (Ofloxacin)
If the patient is a contact lens wearer, what treatment should be given for bacterial conjunctivitis?
-Cover Pseudomonas (Topical Ciprofloxacin or Ofloxacin)
Alternatives are: Topical Aminoglycosides (Tobramycin or Gentamicin)
MCC of viral conjunctivitis?
Adenovirus
Viral conjunctivitis is high contagious from
direct contact
What is the MC source during outbreaks of viral conjunctivitis?
Swimming pools
Symptoms of viral conjunctivitis
- Foreign body or gritty sensation
- Itching
- Normal vision
- Starts unilateral and progresses to bilateral in 1-2 days
- Accompanying viral symptoms
What are some physical exam findings of a patient with viral conjunctivitis?
- Ipsilateral preauricular LAD
- Copious watery tearing
- Punctate staining on slit lamp
What is the treatment for viral conjunctivitis?
- Supportive is mainstay
- Warm to cool compresses
- Artificial tears
- Antihistamines for itching (Olopatadine)
