ENT 1 Flashcards
junction where conjunctiva end and cornea begins
limbus
what are the 2 types of conjunctiva
palpebral (evert lid)
bulbar (around eye itself)
what is tortuosity of capillaires of the retina associated with?
hypertension
uneven pupil size, not necessarily pathological
Anisocoria
area right underneath the conjunctiva
sclera
what can you use to numb the eye?
Tetracaine 0.4%
what is used to check ocular pressure to r/o acute angle glaucoma
tonometry
reasons to refer to a specialist. Red eye+
eye pain, visual disturbance
corneal damage
acute glaucoma
foreign bodies
should a nonopthalmologist prescribe a topical steroid or steroid/abx combo drops?
No, could exacerbate the problem
types of conjunctivitis
allergic
viral
bacterial
chemical
will people with conjunctivits have normal vision?
Yes (may be transient with crusting)
will there be photophobia with conjunctivitis
No
Mucopurulent discharge, usually unilaterly
bacterial conjunctivitis
most common cause of bacterial conjuncivitis
Pneumococcus
H. aegytpicus
Gross purulence with bacterial conjunctivis suggests what?
Neisseria infection
chronic conjunctivitis is usually due to waht?
Staph aureus or moraxella lacunata
Usually bilateral, pre auricular nodes, profuse exudate
Chlamydial conjunctivitis
chronic conjunctivitis from chlamydia trachomatis
Trachoma
Watery discharge, sometimes mucoid. Unilateral quickly spreading to bilateral. Preauricular adenopathy associated w/ fever, pharyngitis.
Viral conjunctivitis
most common cause of viral conjunctivitis
adenovirus
bilateral, pruritus, clear tears. Associated with atopic dermatitis.
allergic conjunctivitis
what connects the eyes to the nose?
nasolacrimal duct
what is bilateral sterile conjunctivitis associated with?
reactive arthritis
What is an example of reactive arthritis
reiter’s syndrome (seronegative spondyloarthropathy)
who is reiter’s syndrome found in/ symptoms
Young men
heel pain
HLA-B27
what other condition is HLA-B27 associated with?
Ankylosing spondylitis
Reiter’s syndrome will other have a prior infection with what?
Klebsiella
C. trachomatis
abdominal infection
What are the 3 reactive arthritises
Steven Johnson syndrome
acne rosacea
Reiter’s syndrome
what may angioedema of lids bilaterally indicate?
systemic allergen
what does unilateral angioedema of lids
local allergenes (topical chemicals, rhus, insect bites)
What is rhus dermatitis
Poison ivy
what does edema of the eyes w/o erythema suggest?
Allergy
Yellow nodule of the scleral conjunctiva
pinguecula
vascularized “redness”; encroaches on cornea, may interfere w/ vision
Pterygium
What are pinguecula and pterygium associated with?
UV exposure
The solution to pollution is…
Dilution
Usually secondary to trauma. Doesn’t cross into iris. Spontaneous with anti-coags. Will include palprebral cojunctiva.
Subconjunctival hemorrhage
massive subconjunctival hemorrhage may be accompanied by what?
proptosis
limited EOMs
What makes eyes stick out with hyperthyroidism
fat pad takes up space
Usually benign inflammation of superficial episceral vessels. Tender, irritated eyes
episcleritis
what is episcleritis associated with?
gout
allergic conditions
psoriasis
collagen disease
underlying ciliary body is inflamed (perilimbal ciliary flush). Photophobia, tearing.
Keratitis
What can cause keratitis
viral
bacterial
sterile
fungal
what common causes corneal limbus infiltrate?
S. aureus
Will have photophobia, concomitant HSV, pain precedes rash. Eyes are sore or painful.
Herpes Simplex Keratoconjunctivitis
blood in the anterior chamber
Hyphema
how long does it take corneal abrasions to heal?
2-3 days as epithelial cells migrate very quickly
what makes up the uveal tract?
Iris
ciliary body
choroid
Will present with pain, photophobia, redness, ciliary flush. Slightly cloudy anterior chamber. Hypopyon
Uveitis
what are some causes of uveal tract dz
Idiopathic conditions
Ankylosing spondylitis, JRA, granulmoatous colitis, sprue, TB, sarcoidosis, trauma/ inflammation
Inflammation of the structures of the lid margin: redness, scaling, crusting
Blepharitis
what usually causes blepharitis on the anterior lid margin.
Staph
Greasy anterior lid scaling
Meibomian gland dysfunction freq.
Seborrheic blepharitis
what is meibomina gland dysfunction associated with?
Seborrheic dermatitis
acne rosacea
Acute staphylococcal infection of the meibomian glands
Internal Hordeolum
Acute staphylococcal infection of the glands of Zeis or Moll around rashes
External hordeolum or sty
Sterile granulomatous inflammation of the meibomian gland
Tender, mildly inflamed OR quiet discrete mass
Physically disfiguring
Chalazion
Infection of tear duct on lateral nose.
Purulent matter may be expressed
Acute Dacryocystitis
What type organism usually causes orbital cellulitis?
Gram positive organism
swollen, red eyelids with chemosis, painexopthalmos, fever, leukocytosis
Orbital cellulitis
what can orbital cellulitis lead to?
third, fourth, and sixth cranial nerve or ophthalmic division of the fifth cranial nerve.
Cavernous sinus thrombosis
Painful, unilateral red eye, ciliary flush.
Pupil: mid-dilated, fixed.
Cornea: cloudy secondary to edema.
acute glaucoma
What must IOP be above for acute glaucoma?
> 20 mm Hg
what will the patient’s vision be like with acute glaucoma
cloudy vision
halo around lights
N/V/Headache
s swelling of the tissue that lines the eyelids and surface of the eye (conjunctiva) (palpebral)
chemosis
what may precipitate acute glaucoma
Mydriatic activity (dark movie theatre) or stress
most common cause of impaired vision?
refractive error
Most common cause of impaired vision?
myopia
what drugs can lead to impaired vision
sulfonamides
thiazides
anti-cholinergics
with myopia where if the refraction compared to the fovea?
anterior to the fovea
what is “curtain” drawn down over vision
retinal detachment
what are 2 anterior diseases that can impair vision?
Hyphema
iritis
leading cause of blindness in those over age 50. central vision is impaired
macular degeneration
what type disease is macular degeneration
retinal disease
what can cause retinal inflammation
Histoplasmosis, toxoplasmosis, cytomegalovirus, herpes virus.
Immunocompromised patients
cherry red spot on macula indicates what
central artery retinal occlusion
what are box car veins?
Veins with skips in them
what is associated with central retinal artery occlusion
cherry red spot
box car veins
most common cause of central artery retinal occlusion
Emboli (a-fib)
vegetations from mitral valve leaflet
Granulomatous inflammation of medium and large arteries in elderly
Giant cell or temporal arteritis
what is giant cell or temporal arteritis associated with
polymyalgia rheumatica elevated ESR (sed rate)
Inflammation of optic nerve. Loss of color vision. Globe tender and visual field defect.
optic neuritis
Tx for optic neuritis
steroids
exam is normal, objective measurement intact.
psychogenic impaired vision
Autoimmune inflammation w infiltration of the soft tissues of the orbit
Lid retraction, lid lag, stare, mild protrusion of the eye (proptosis).
Graves Dz
Risk factors for graves Dz
smoking
hyperthyroid (persistent/ DC ant thyroid drug Rx)
causes of exopthalmos
tumor
graves’ disease
vascular causes
vascular causes of exopthalmos
hemangioma aneurysm varices carotid-cavernous sinus fistula cavernous sinus thrombosis
Leading cause of blindness under age 65
diabetic retinopathy
2 types of diabetic retinopathy
nonproliferative (generally early form)
proliferative (later stage/ worse prognosis)
have microaneurysms, intraretinal hemorrhages, cotton wool infactions, serious and lipid exudates. Intraretinal vascular damage
non-prolifeative retinopathy
vascular pathology extending from retina into vitreous cavity. Late stage of dz, worse prognosis.
proliferative retinopathy
Fine network of small vessels from optic disc, maj.ret.vessels, or areas adjacent to retinal ischemia.
neovascularization
what is neovascularization seen with?
proliferative retinopathy
if iris is involved in proliferative retinopathy, what is there a higher risk of
glaucoma
presents with flame hemorrhage, AV nicking, arteriolar narrowing, increased vascular tortuosity.
Hypertensive retinopathy
a lesion in the optic chiasm leads to what?
bitemporal hemianopsia
what can bitemporal heminaopsia be a sign of?
pituiatary adenoma
