EM Ophtha 5 Flashcards
stye is an
acute bacterial infection (usually Staphylococcus) of the follicle of an eyelash and adjacent sebaceous glands (ZEIS) or sweat glands (MOLL)
stye = external hordeolum
internal hordeolum = acute bacterial infection of the meibomian glands
treatment of stye
stye = external hordeolum
tx:
warm compresses
erythromycin ophthalmic ointment TWICE daily for 7-10 days
systemic antibiotics if with significant surrounding cellulitis
possible I&D
what is chalazion
subacute to chronic painless lump secondary to blackage of meibomian or Zeis ooil glands in the tarsal plate
tx the same as internal hordeolum
may requir corticosteroids infection into lesino or I&D
refer to ophtha in 1-2 weeks
what is blepharitis
inflammation of eyelash follicles
most common cause is overgrowth of S. epidermidis, and the inflam is largely a reaction to the deltalike toxin
symptoms: conjunctival inection, crusting, swollen and pruritic eyelids, occasional eye pain
tx: careful daily cleansing of the edges of eyelids and eyelashes
if severe, may require antibiotic drops or ointment at night
remarks on subconjunctival hemorrhage
reassurance is the only treatment necessary
hemorrhage usually resolves within 2 weeks
fluorescein staining in herpes keratitis
classically a linear branching pattern with terminal bulbs, or
may be a “geographic ulcer”, which is an amoeba-shaped ulceration with dendrites at the edge
tx of herpes simplex keratoconjunctivitis
oral acyclovir, 500 g 5x daily, or
famciclovir 500 mg 3x daily
For conjunctival involvement:
topical trifluridine, 1 drop 9x a day
alt:
Idoxuridine, 1 drop every 1 hours during the day and every 2 hours at night
to prevent bacterial infection:
erythromycin ophthalmic ointment
do NOT prescribe topical steroids, and refer patients to an ophthalmologist in 24-48 hours
hutchinson sign
seen in herpes zoster ophthalmicus
involvement of the nasociliary nerve associated with cutaneou lesions on the tip of the nose
hutchinson sign = high likelihood of ocular involvement
tx of herpes zoster ophthalmicus
- skin involvement - cool compresses
- rash <1 week: oral antiviral x 7-10 days
ACYCLOVIR 800 mg 5x daily
FAMCICLOVIR 500 mg 3x daily
VALACYCLOVIR 1000 mg 3x daily - cutaneous lesion:
bacitracin or erythromycin ointment - conjunctivitis:
erythromycin ophthalmic ointment TWICE a day
5 iritis:
topical steroids such as
prenisolone acetate 1%, 1 droip 4-5x a day, BUT consultation with an ophthalmologist is recommended first
- significant pain:
consider topical cycloplegic agents
CYCLOPENTOLATE 1%, 1 rop 3x daily
symptoms of iritis/uveitis
CONSENSUAL photophobia due to ciliary spasm
-HIGHLY SUGGESTIVE OF IRITIS
unilateral eye pain
decreased vision
NO DISCHARGE
systemic symptoms
- arthritis
- urethritis
- recurrent GI symptoms
PE:
perilimbal flush
miosis
flare and cells in the anterior chamber on slit lamp exam
treament of corneal ulcers
treat aggressively with topical antibiotics
EMEREGENT ophthalmologic consultation for culture of the ulcer and institution of appropriate antibiotics (within 12-24 hours?)
CIPROFLOXACIN or OFLOXACIN, 1 drop EVERY HOUR in the affected eye is the current recommended treatment
if fungal infection is suspected, natamycin, amphotericin B, or fluconazole at the direction of an ophthalmologist
if with accompanying iritis:
CYCLOPENTOLATE 1% (cycloplegic)
do NOT give steroids
do NOT patch eye bec of risk of pseudomonas infection
complications of corneal uclers
corneal scarring
corneal perforation
ant and post synechiae
glaucoma
cataracts
causes of uveitis/iritis
most common
in US: systemic inflammatory diseases (e.g.juvenile rheumatoid arthritis, Reiter syndrome, ankylosing spondylitis)
in Asia: infectious, most commonly TB
remarks on iritis
not a true ocular emergency, but does require prompt folow-up by an opthalmologist
some TRUE ocular emergencies
extension of bleeding from traumatic peri orbital hematomas (black eyes) into the postseptal comparment
chemical burns (irrigate with 1-2L of normal saline for at least 30 minutes)
tx of iritis
depends on underlying cause
to decrease pain, block the pupillary sphincter and ciliary body with long-acting cycloplegic, such as
HOMATROPINE (duration of 2-4 days) or
TROPICAMIDE (duration 24 hours)
Refer to ophtha in 24-48 hours for topical corticosteroiddds and further mgt
causes of endophthalmitis
most common: POSTSURGICAL
followed by
-penetrating ocular injuries
-rarely, hematogenous spread
symptoms of endophthalmitis
eye pain vision loss photophobia headache OCULAR DISCHARGE
+ history of
a. postsurgical
b. high-speed machineries or ocular trauma
tx of endophthalmitis
EMERGENT ophthalmologic consultation
Tx includes
- aspiration of the vitreous or pars plana vitrectomy
- administration of intravitreal antibiotics and steroids, in addition to systemic antibioitcs
admission is required, except for postoperative cases
EMERGENT ophtha consult
- post septal cellulitis
- corneal ulcers
- endophthalmitis
- retinal detachment (requires retina specialist to evaluatte and treat the patient)
- globe laceration or rupture
- nerve entrapment in blowout fractures
- glaucoma
causes of vitreous hemorrhage
most common:
proliferative diabetic retinopathy
posterior vitreous detachment in the elderly
ocular trauma such as shaken baby syndrome in infants
unusual cause: subhyaloid hemorrhage assoc’d with SAH
Features of vitreous detachment and hemorrhage
painless vision loss
sudden appearance of black spots, cobwebs, or generalized unilateral hazy vision
dm or sickle cell disease
Clinical features of CRAO
Sudden (occurring over seconds), profound, painless, monocular loss of vision - characteristic of CRAO
The event is often preceded by episodes of AMAUROSIS FUGAX (transient visual loss)
PE
afferent pupillary defect
pale retina
cherry red macula
