External disorders of the eyes Flashcards
Rupture of blood vessels under conjunctiva
Subconjunctival Hemorrhage
Subconjunctival Hemorrhage risk factors
- Blood thinners
- Bleeding disorders
- Severe HTN
- LASIK
Common causes of Subconjunctival Hemorrhage
- Esp. in the elderly (>80 yo)
- Due to systemic disease (ie HTN)
- <40 yo usually 2° ocular conditions
- Minor trauma most often
Subconjunctival Hemorrhage pathophysiology
Spontaneous
* Blood vessels under the conjunctiva are
very small, very fragile
* Rupture easily (coughing, sneezing, vomiting, childbirth, trauma)
Subconjunctival Hemorrhage presentation - is it painful?
- No additional symptoms
- Rarely painful
- Sense of awareness of the eye
What is this
Subconjunctival hemorrhage
What is this?
Conjunctivitis (pink eye)
Epidemiology of conjunctivitis
- Infectious
- Bacterial – Most Common Causes
- Adults: S. Aureus most common
- Children: S. pneumoniae, H. influenzae, M. catarrhalis
- Sexually Transmitted: Chlamydial
- Viral – typically adenovirus
- Non-infectious
- Allergic
- Non-Allergic – most common = dry eye
Most common eye disease
Conjunctivitis
Conjunctivitis presentation
Itching
* Discharge with crusting
* Discomfort
* Often bilateral
Conjunctivitis exam findings
***Conjunctival injection
* Chemosis (swelling of conjunctiva)
* Discharge
* Foreign body sensation
* Photophobia
* Tearing
Chlamydial conjunctivitis presentation
- Chronic onset
- STD risk factors
- Itching
- Minimal pain
- Inclusion conjunctivitis
- Conjunctival discharge is minimal & seropurulent
Epidemic Keratoconjunctivitis (EPC) is
Viral conjunctivitis
* Adenovirus infection – Most common worldwide
___ Can be confused with EPC without fluorescein staining
HSV
Allergic conjunctivitis presentation
“Hay fever”
* Acute or subacute onset
* No pain
* No history of known illness exposure
* Significant itching
* Clear, watery discharge
Conjunctivitis treatment
- Supportive care
- Artificial tears
- Cold, moist compress
- Handwashing
- Olopatadine(Pataday®) – Allergic Conjunctivitis
- Antibiotic drops – Bacterial Conjunctivitis
4 clinical factors found to be independently associated with a negative conjunctival culture result
- Age → 6 years or older
- Time → April through November
- Discharge → None or watery discharge
- Eye matting → No glued eye in the morning
Chalazion/Hordeolum
Focal swelling of the eyelid
What is this called
Chalazion/Hordeolum
Hard, painless lid nodule
Chalazion
Chalazion presentation
- Painless swelling
- Weeks to months
- May become painful or impair vision as it progresses
Acute focal infection meibomian glands
Hordeolum
Hordeolum presentation
Focal abscess
* Acute inflammation
* Discomfort
* Warmth
* Swelling
Chalazion/Hordeolum treatment
- Self-limited with improvement in 1-2 weeks
- Eyelid hygiene
1 in 10,000 ophthalmic patients will have this
Dacryoadenitis
Inflammatory enlargement of the lacrimal gland
Dacryoadenitis
What is this
Dacryoadenitis
Acute vs. Chronic Presentation of Dacryoadenitis
Acute
* Onset of hours to days
* Unilateral
* Severe pain
* Redness
* Proptosis
* Supratemporal pressure
Chronic
* Bilateral
* Painless
* Lacrimal duct enlarged > 1 month
* More common
* mild ptosis
Dacryoadenitis diagnosis
- Acute may require bacterial
& fungal cultures - CT scan of the orbits
Dacryoadenitis treatment
- Viral self-limiting
- Bacterial
- Cephalexin (Keflex®)
- Culture-directed
- Treat any underlying conditions
- Sarcoidosis, Sjogren Graves
“Dry eye syndrome”
Keratoconjunctivitis Sicca
What is this
Keratoconjunctivitis Sicca
Often associated with Sjogren syndrome
Keratoconjunctivitis Sicca
3 primary layers of the tear film
Lipid, Aqueous, & mucus (mucin)
How can you see the exposed epithelium that occurs with dry eyes?
Damaged epithelial cells shed
* Visible via punctate staining when
the corneal surface is flooded with
fluorescein
Keratoconjunctivitis Sicca diagnosis
- Staining
- Rose Bengal
- lissamine green
- Fluorescein staining
- Schirmer test
Schirmer test
- Eyes are closed for 5 minutes
- Measured in mm of moisture
on filter paper - Normal = >10 mm
Keratoconjunctivitis Sicca treatment
- Prevent ulceration & scarring
- Artificial tears
- Drops, gels, ointments
- Topical cyclosporine
- Topical or systemic omega-3 fatty acids
- Eye protection
Blepharitis
Inflammation of the eyelid
What is this called
Blepharitis - anterior
Anterior blepharitis pathophysiology
- Bilateral, chronic
- Inflammation of eyelid margins
- Staphylococcal
- Seborrheic
- Associated with seborrheic dermatitis
Posterior Blepharitis pathophysiology
- The result of meibomian gland dysfunction
- Bilateral, chronic
What is this?
Blepharitis - Posterior
Blepharitis clinical presentation
Erythema, crusting, & matting of the lashes & lid margins
Good eyelid hygiene
Moist heat (warm eyelid gland secretions)
* Wash eyelid margin to remove adherent
material
* 2-3 drops, baby shampoo mixed in one
bottle cap full of warm water
* Antibiotic ointment to the eyelid margin
* Bacitracin, Polymyxin B, Erythromycin
Pinguecula
Small, yellow conjunctival growth
Pinguecula pathophysiology
- Hyperplasia of the conjunctival tissue
- Environmental irritation
- UV exposure
What is this?
Pinguecula
Pinguecula management
- Observation
- Minimize UV exposure
- Topical steroid drops
Pterygium
Fleshy, triangular encroachment of a pinguecula onto the cornea
What is this
Pterygium
Pterygium epidemiology
- Usually on the nasal side bilaterally
- Fibrovascular proliferation in response to environmental
irritation - UV exposure, windy environment
- “Surfer’s eye”
- More common closer to the equator
Clinical Presentation of Pterygium
Ranges from no symptoms to redess, swelling and blurred vision
A _____ May grow over cornea &
block vision
Pterygium
Pterygium Treatment
- Observation, minimize UV exposure
- Referral for removal
Arcus Senilis
Bilateral white-gray peripheral ring
T/F Arcus Senilis has No effect on vision
T
Ptosis (Blepharoptosis)
Abnormal low-lying upper eyelid margin with the eye in primary gaze
Congenital Horner’s Syndrome
- Mild ptosis, miosis with ↓ iris pigmentation & heterochromia
- Failure of development of the sympathetic
nervous chain may be responsible
Most common cause of ptosis
Improper levator muscle
development
Entropion
Eyelid turns inward
What is this called
Entropion
Trichiasis
Misdirection of eyelashes toward the cornea
* Corneal irritation & encourages ulceration
Ectropion
Eyelid turns outward
What is this called
Ectropion
