exam 1: 1-25 Flashcards
anterior blepharitis patho: -\_\_\_\_\_ inflammation of the \_\_\_\_\_ margin -\_\_\_\_\_: due to infection by staph -\_\_\_\_\_: in association with seborrhea of the \_\_\_\_\_, \_\_\_\_\_ and \_\_\_\_\_
S/S:
- Irritation, _____, _____
- eyes are _____
- _____ and granulations can be seen clinging to the lashes
Treatments:
- Controlled by _____ of the lid margins, eyebrows and scalp
- Scales should be removed from the lids daily with a _____ or a damp cotton applicator and baby shampoo
- Acute exacerbations: Antistaphylococcal antibiotic eye ointment applied daily to the lid margins, bacitracin or erythromycin
Bilateral eyelid Ulcerative Seborrheic scalp brows ears burning itching “red-rimmed” scales cleanliness hot wash cloth
posterior blepharitis
patho:
- inflammation of the _____
- Bacterial infection particularly with _____
S/S:
-Lid margins are _____ with telangiectasias, Meibomian glands and orifices are inflamed, lid margin frequently rolled _____ to produce mild _____, tears may be _____ or abnormally _____
treatments:
only if inflammation of conjunctiva and cornea:
-Long term low dose oral _____ therapy: Tetracycline, Doxycycline, Minocycline, Erythromycin
-Possible short-term _____: Prednisolone 0.125%
-Topical therapy with antibiotics may be helpful but should be restricted to short course: Ciprofloxacin 0.3% opthalmic solution
meibomian glands staph hyperemic inward entropion frothy greasy antibiotic corticosteroids
chalazion
patho:
-_____ inflammation of the Meibomian gland. Can follow a _____.
S/S:
- Hard, _____ swelling on _____ surface of the eyelid. If large enough to press on _____, it can impair vision.
- Redness and swelling of the adjacent conjunctive
treatment:
- Initial treatment: _____
- After 2-3 weeks, removal by an ophthalmologist.
- Steroid injection
Granulomatous hordeolum nontender conjunctival cornea warm compresses
entropion
patho:
-As a result of degeneration of the lid _____, or may follow extensive scarring of the conjunctiva and tarsus
S/S:
-_____ turning of the usually the lower lid
epiemiology:
- elderly
treatment:
- _____ is indicated if the lashes rub on the cornea
- _____ injections may be also used for temporary correction
fascia
Inward
Surgery
Botulinum toxin
Tests that distinguish conductive from sensorineural hearing loss. Findings on Webber and Rinne for conductive hearing loss vs. sensorineural hearing loss.
-In the Weber test, the tuning fork is placed on the forehead or front teeth. In conductive losses, the sound appears louder in the _____ ear, whereas in sensorineural losses it radiates to the _____. In the Rinne test, the tuning fork is placed alternately on the mastoid bone and in front of the ear canal. In conductive losses greater than 25 dB, _____ conduction exceeds _____conduction; in sensorineural losses, the opposite is true.
poorer-hearing
better side
bone
air
bacterial conjunctivitis
patho:
-Most common organisms: Staph including _____, Strep. particularly _____, Haemophilus, Pseudomonas and Moraxella
S/S:
- _____ discharge, no blurred vision, mild discomfort
- Lid _____
- Eye stuck shut in the morning
tests:
-Severe cases examine conjunctival scrapings and cultures – rule out gonococcal infection
treatment:
- _____ 10-14 days
- Topical _____ or oral antibiotic will usually clear infection in 2-3 days
- Except in special circumstances (contact lens wearers), use of topical fluoroquinolones is rarely justified for treatment
MRSA S. pneumoniae Copious purulent crusting Self-limiting sulfonamide
gonococcal conjunctivitis
patho:
-Contact with infected _____ secretions
S/S:
-_____ discharge
tests:
- Rule out other STI’s
- diagnosis should be stain, smear, and culture of discharge
treatments:
- _____ 1g IM
- Topical antibiotics – erythromycin & bacitracin
- Treat for chlamydial infection – oral doxycycline & azithromycin
misc: ophthalmologic emergency – possible corneal perforation
genital
Copious purulent
Ceftriaxone
Chlamydial keratoconjunctivitis (Trachoma)
patho:
-Trachoma (most common infectious cause of _____ worldwide)
S/S:
- Corneal scarring
- _____ (inward eyelid)
- _____ (inward eye lashes)
tests:
-Immunologic PCR testing to confirm
prevention:
-Improved hygiene & living conditions
treatment:
- 1 g _____
- Surgical treatment may be necessary for deformities
blindness
Entropion
Trichiasis
Azithromycin
viral conjunctivitis
patho:
-_____ most common cause
-HSV conjunctivitis: unilateral with lid vesicles
-Enterovirus 70 or coxsackievirus A24: hemorrhagic conjunctivitis
S/S:
- _____
- _____ discharge
- Marked _____ sensation
- _____ conjunctivitis
tx:
- HSV conjunctivitis
- Topical ganciclovir 0.15%
- Oral acyclovir
- All others – no specific treatment
- No specific treatment - _____
- _____ and/or artificial tears to reduce discomfort
misc:
-Swimming pool most common source during outbreaks
Adenovirus Bilateral Copious watery foreign body follicular self-limited Cold compresses
“Allergy Eye” – Allergic conjunctivitis, vernal conjunctivitis, Atopic keratoconjunctivitis
patho:
-Allergic
-Seasonal: spring, summer, or perennial
-Vernal
-Spring mostly
-contact of allergen with eye causes mast cell degranulation and release of histamine
S/S: Mild: Itching, redness, \_\_\_\_\_ discharge Severe: \_\_\_\_\_ and \_\_\_\_\_ loss Allergic: -\_\_\_\_\_ (dilated blood vessels) and edema (chemosis)
Vernal
- Large “_____” papillae upper tarsal conjunctiva
- May be lymphoid follicles of limbus
- _____ may occur
Atopic- adulthood
- Upper and lower tarsal conjunctiva (mucosal side of eyelids) papillary conjunctivitis
- Severe: Conjunctival fibrosis, _____ shortening (will restrict eye movements) and _____ with _____
tx: Anti-inflammatory agents Topical: -Mast Cell Stabilizers -\_\_\_\_\_ -Vasoconstrictors
stringy photophobia visual hyperemia cobblestone Corneal ulceration fornix entropion trichiasis Antihistamines
Keratoconjunctivitis Sicca (Dry Eyes) patho: -Due to: -\_\_\_\_\_ -Hereditary disorders, \_\_\_\_\_ disease (Sjogren syndrome- malfunction of moisture secreting glands), systemic drugs (antidepressants, anticholinergics, etc.) -Excessive evaporation of \_\_\_\_\_ due to environmental factors (hot, dry, windy climate) -\_\_\_\_\_ deficiency -Conjunctival \_\_\_\_\_
S/S:
- Hypofunction of _____ causing loss of aqueous component of tears
- Dryness
- Redness
- _____ sensation
- Severe cases:
- -Persistent marked discomfort w _____
- -Difficulty in moving the eyelids
- -Excessive mucus secretion
tests:
- May reveal no abnormality on inspection
- _____
- Schirmer test (>10mm in 5 minutes is normal)
- Measures rate of production of the aqueous component of tears
tx:
- Artificial tears
- Sodium chloride in physiologic (0.9%NS) or hypo-osmotic (0.45%NS) solutions
- Drop preparations with a mucomimetic: hydroxypropopyl methylcellulose (HPMC) or carboxymethycellulose (carmellose).
- More prolonged action
- Tenacious mucus: mucolytic agents (topical acetylcysteine)
Aging systemic tears Mucin scarring lacrimal glands Foreign body photophobia Slit lamp
cataracts patho: -\_\_\_\_\_ is most common cause -Usually bilateral, congenital (rubella, CMV) traumatic, secondary to systemic disease (diabetes, atopic dermatitis, myotonic dystrophy), due to CS, or uveitis or radiation exposure. Long-term \_\_\_\_\_ use a risk factor. Statins. -\_\_\_\_\_ of the crystalline lens
S/S:
- Gradual progressive blurred vision.
- _____ especially in bright light or when driving at night
- Change of focusing – development of _____
- Monocular double vision
- No _____ or redness.
- Lens opacities may be visible
tests:
- Early stages: seen through a dilated pupil with an _____
- Cataract matures
- -Retina increasingly difficult to visualize
- -Finally, _____ is absent and the pupil is _____.
prevention
- Multivitamin/mineral supplements
- High dietary antioxidants
tx:
- _____ removal
- Laser treatment
- Ultrasonic fragmentation (phacoemulsification) of the lens and foldable intraocular lenses
Age steroid Opacities Glare nearsightedness pain ophthalmoscope fundus reflection white Surgical
corneal abrasions S/S: -\_\_\_\_\_ pain -\_\_\_\_\_ -History of trauma to the eye -Fingernail, piece of paper or contact lens
tests:
- Cornea and conjunctiva examined with a light and loupe to r/o foreign body
- Sterile _____
- Abrasion will stain a deeper green than surrounding cornea
tx:
- _____ ointment
- Mydriatic (cyclopentolate 1%)
- Dilates the eye
- Analgesics (topical or oral NSAIDS)
Severe
Photophobia
fluorescein
Bacitracin-polymyxin ophthalmic
anterior uveitis
patho:
-Intraocular inflammation – _____ or _____
-Primarily immunologic but injection may be the cause
Acute non granulomatous anterior uveitis:
- herpes simplex,
- herpes zoster,
- retinitis,
- HLA-B27 related conditions: ankylosing spondylitis, reactive arthritis, psoriasis, ulcerative colitis and Crohn disease
Causes of anterior and posterior uveitis:
- Sarcoidosis
- Toxoplasmosis
- TB
- Syphillis
- Ocular infections associated with HIV
S/S:
Anterior uveitis: inflammatory cells and flare within the aqueous
-‘_____”
-Cells = WBCs
-Flare = proteins in the vitreous humor
-Severe cases:
-_____ – layered white blood cells
-Cells may be seen on corneal endothelium: _____
Granulomatous
- Large “_____” KPs
- Iris _____
- Blurred vision in a mildly inflammed eye
Non granulomatous
- KPs are _____
- Iris nodules not seen
- Pupil is usually small with development of posterior synechiae
- Unilateral pain
- _____
- Photophobia
- Visual loss
Tx:
-Topical _____
iris ciliary body Cells & flare Hypopyon keratic precipitates mutton-fat nodules smaller Redness corticosteroids
posterior uveitis
patho:
-_____ inflammation
-Visual loss may be due to vitreous haze and opacities, inflammatory lesions involving the _____, macular _____, retinal vein occlusion, or rarely associated optic neuropathy
S/S:
- Gradual loss of vision in a _____ eye
- Cells in the _____
- Inflammatory lesions present in the retina or choroid
- Fresh lesions are _____ with _____ margins and there may be retinal hemorrhages
- Older lesions have more definitive margins and are commonly _____
- Retinal vessel sheathing may occur adjacent to such lesions or more diffusely
- Severe cases: _____ occludes the retina on visualization
- Presents with gradual visual loss in a relatively quiet eye
- Bilateral involvement is common
tx:
-Systemic, periocular, or intravitreal _____ therapy
Choroid macula edema quiet vitreous yellow indistinct pigmented vitreous opacity corticosteroid
