EENT- Eye Flashcards
34 y/o F presents with acute left sided eye pain. It is worse with movements, especially lateral and medial. Her vision in decreased in the left. Exam shows a afferent pupillary defect and some mild optic disc swelling.
dx
tx
presentation of optic neuritis
would likely get MRI brain/orbits
IV methylprednisone transition to PO pred
should return to normal
How would you diagnose a suspected corneal abrasion?
Fluorescein drops
FP with rust ring present, tx
25g needle or drill with burr
abx, anesthetic eye drop
f/u ophth 1-2 days
Contact users who sustain corneal abrasion that is superficial and FB easily removed with cotton tip. Tx
Contact uses require
Ciprofloxacin
Keep contacts out for 7 days/until healed
When can you patch for treatment for corneal abrasion?
DONT
Corneal ulcers most commonly due to
infection
RF for corneal ulcer
contact lens use dry eye states/ ocular surface dis HIV trauma, ocular sx smoking low SEC status
Common bacteria seen in corneal ulcer
staphylococcus, pseudomonas
How would you diagnose a suspected ulcer
fluorescein eye drop
Pt presents with right eye pain, photophobia, tearing and FB sensation. There is erythema of the conjunctiva and corneal injection. Fluorescein stain demonstrates a dendritic lesion. Dx and Tx
HSV Keratitis/Ulceration
Tx with Acyclovir PO (sometimes drops)
Cycloplegic drops (cyclopentolate 1%) for pain
Tx chalazion
warm compress and lid scrubs
refractory >1m I&D
Hard, non-tender swelling on lid with redness and swelling of adjacent conjunctiva
Chalazion
Patho of chalazion
granulmatous inflamm of meibomian gland likely following internal hordeolum
MCC conjunctivitis
Adenovirus
Anterior Blepharitis involves what location?
Pathophysiology?
eyelid skin, eyelashes, glands
ulcerative secondary to staph infec or from seborrhea
Posterior Blepharitis involves what location?
Pathophysiology?
inflamm of meibomian from primary glandular dysfx
-strong association with acne rosacea
or bacterial infect
18 y/o male presents with bilat eye that are red rimmed. He complains of itching and a FB sensation. On exam you note scales clinging to the lashes.
Dx
Tx
Anterior Blepharitis- likely seborrheic
warm compresses BID followed by eyelid scrubs
abx only if sxs secondary infection
24 y/o female presents with c/o bilat itching eyes and irritation. It has been bothering her for 1 1/2 weeks. On exam you see hyperemic lid margins with telangiectasis. Palpation of meimobian glands causes mild expectorant of a clear oily substance.
Dx
Tx
Posterior Blepharitis
warm compresses BID followed by eyelid scrubs
if sxs rosacea then PO doxy
Patho for hordeolum
staphylococcal abscess on upper or lower lid
internal = meibomian gland abscess
external (aka sty) = Zeis/Moll abscess
14 y/o F with R eye tearing and itching. Lower lid has internal bump that is acutely painful. There is mild erythema and swelling.
Tx and recommendations
Hordeolum
warm compresses several times a per day x48hrs
I&D if no improvement in 2days
7 y/o M presents with unilat mild eye irritation and copious purulent DC. In the morning his eye was crusted over. He reports his friend at school recently had “pink eye”.
Likely bacterial conjunctivitis
topical sulfonamide or PO abx
Unilat lacrimal sac swollen, red, tender
dx
tx
Dacryocystitis
PO Augmentin, Cephalexin
warm compress
inward turning of the eyelid
entropion
Treatment for Ectropion
tape eyelid in place temporarily until sx
artificial tears/lubricants
Treatment for Entropion
Artificial tears/lubricants
A few stitches in the office, hold in place until sx
fleshy overgrowth of conjunctiva onto cornea
“wing shaped” vascular overgrowth
Pterygium
yellow elevated conjunctival node on nasal side
Pinguecula
MCC of cataract
Aging
Patho of cataract
change in lens protein lead to opacification
Leading cause of blindness worldwide
Cataract
64 y/o M with a PMH of CAD and HTN (now controlled) presents with c/o bilat progressive bluring of vision. He says he has increased glare and driving at night is extremely bothersome. On exam his retina is difficult to visualize and he has an absent red reflex bilat.
Dx
Tx
Cataracts
Surgery
45 y/o AAM hx of DM presents with insidious loss of peripheral vision and c/o “halos around lights”. Exam reveals IOP of 24 and slightly enlarged disk/cup ratio
Dx
Tx
Open Angle Glaucoma
Referral-
B adrenergic drops
Timolol, Levobunolol
Alpha Adrenergic Agonist drops
Apraclonidine
~Laser trabeculectomyDrugs that can cause acute angle closure glaucoma
SULFA
anticholinergics
sympathomimetics
+ others, sometimes even acetazolamide….
Beta adrenergic drops like Timolol and Levobunolol are contraindicated in what other disease states
Asthma
Cardiac conduction disorders
Normal IOP
10-20mmHg
37 y/o Asian man presents to PCP with acute onset unilat HA and aching brow pain. He c/o of halos around lights. On exam you note a red eye and steamy cornea with a fixed mid-dilated pupil.
w/o
tx
Check IOP- likely in 40s and up
Examine cornea- likely CORNEAL EDEMA
Angle Closure Glaucoma
Tx- IV acetazolamide
topical Badrenergic, alpha agonist
Definitive tx- laser iridotomy
Exam findings classic for HTN retinopathy
AV nicking, arteriolar narrowing
~retinal hemorrhages, microanuerysms, optic nerve swelling
DBP of ______ causes retinal vessels to narrow and straighten
90-110mmHg
DBP of _______ causes leakage of plasma proteins and blood products
110-115mmHg
DBP of ______ causes optic nerve swelling
130-140mmHg
Patho of cotton-wool spots
ischemia to nerve fiber
Neovascularization and vitreous body hemorrhage classic for what dx?
Proliferative DM Retinopathy
Microaneurysms, venous dilation, and hard exudates seen in what dx?
Non-prolif DM Retinopathy
Unilat swelling with redness of lid with proptosis, fever, and restricted EOM recent hx sinusistis
Orbital Cellulitis
Nafcillin
Tx hyphema
Elevate HOB, limit activity
~eye shield (not a patch)
Avoid ASA, NSAID- acetaminophen only
referral to ophthalmologist
24 y/o M presents to ED following bar fight for skin lac to medial nose. It is grossly swollen. On exam you not a 4 cm lac and orbital crepitus. He reports some facial numbness on his upper lip on that side and has double vision when looking up
Blow out fracture with nerve entrapment/injury
tear drop sign
orbital fat herniated into maxillary sinus
blow out fx
45 y/o F with hx of near-sighteness and DM presents to ED with 2 day hx of increasing floaters and flashes of light and 1 hr hx of curtain moving over her field of vision.
Dx
Retinal Detachment presentation
Acute PAINLESS vision loss
pyknosis-whitened retina
Cherry Red dot of fovea
Retinal Artery Occlusion
PAINFUL unilat vision loss
exam with dilated tortuous retinal veins
Retinal Vein Occlusion
Drusen are characteristic of what disease process
macular degeneration
Hard drusen
pigment changes
amsler grid changes
Non-exudative/Dry Macular Degeneratoin
Soft drusen
neovascularization
scarring
Exudative/Wet Macular Degeneration
infantile esotropia treatment
surgery
crossed eyed
esotropia
