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EENT Exam 1 > External disorders of the eyes > Flashcards

External disorders of the eyes Flashcards

1
Q

Rupture of blood vessels under conjunctiva

A

Subconjunctival Hemorrhage

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2
Q

Subconjunctival Hemorrhage risk factors

A
  • Blood thinners
  • Bleeding disorders
  • Severe HTN
  • LASIK
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3
Q

Common causes of Subconjunctival Hemorrhage

A
  • Esp. in the elderly (>80 yo)
  • Due to systemic disease (ie HTN)
  • <40 yo usually 2° ocular conditions
  • Minor trauma most often
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4
Q

Subconjunctival Hemorrhage pathophysiology

A

Spontaneous
* Blood vessels under the conjunctiva are
very small, very fragile
* Rupture easily (coughing, sneezing, vomiting, childbirth, trauma)

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5
Q

Subconjunctival Hemorrhage presentation - is it painful?

A
  • No additional symptoms
  • Rarely painful
  • Sense of awareness of the eye
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6
Q

What is this

A

Subconjunctival hemorrhage

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7
Q

What is this?

A

Conjunctivitis (pink eye)

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8
Q

Epidemiology of conjunctivitis

A
  • 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
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9
Q

Most common eye disease

A

Conjunctivitis

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10
Q

Conjunctivitis presentation

A

Itching
* Discharge with crusting
* Discomfort
* Often bilateral

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11
Q

Conjunctivitis exam findings

A

***Conjunctival injection
* Chemosis (swelling of conjunctiva)
* Discharge
* Foreign body sensation
* Photophobia
* Tearing

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12
Q

Chlamydial conjunctivitis presentation

A
  • Chronic onset
  • STD risk factors
  • Itching
  • Minimal pain
  • Inclusion conjunctivitis
  • Conjunctival discharge is minimal & seropurulent
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13
Q

Epidemic Keratoconjunctivitis (EPC) is

A

Viral conjunctivitis
* Adenovirus infection – Most common worldwide

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14
Q

___ Can be confused with EPC without fluorescein staining

A

HSV

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15
Q

Allergic conjunctivitis presentation

A

“Hay fever”
* Acute or subacute onset
* No pain
* No history of known illness exposure
* Significant itching
* Clear, watery discharge

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16
Q

Conjunctivitis treatment

A
  • Supportive care
  • Artificial tears
  • Cold, moist compress
  • Handwashing
  • Olopatadine(Pataday®) – Allergic Conjunctivitis
  • Antibiotic drops – Bacterial Conjunctivitis
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17
Q

4 clinical factors found to be independently associated with a negative conjunctival culture result

A
  1. Age → 6 years or older
  2. Time → April through November
  3. Discharge → None or watery discharge
  4. Eye matting → No glued eye in the morning
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18
Q

Chalazion/Hordeolum

A

Focal swelling of the eyelid

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19
Q

What is this called

A

Chalazion/Hordeolum

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19
Q

Hard, painless lid nodule

A

Chalazion

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19
Q

Chalazion presentation

A
  • Painless swelling
  • Weeks to months
  • May become painful or impair vision as it progresses
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20
Q

Acute focal infection meibomian glands

A

Hordeolum

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21
Q

Hordeolum presentation

A

Focal abscess
* Acute inflammation
* Discomfort
* Warmth
* Swelling

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22
Q

Chalazion/Hordeolum treatment

A
  • Self-limited with improvement in 1-2 weeks
  • Eyelid hygiene
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23
Q

1 in 10,000 ophthalmic patients will have this

A

Dacryoadenitis

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24
Q

Inflammatory enlargement of the lacrimal gland

A

Dacryoadenitis

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25
Q

What is this

A

Dacryoadenitis

26
Q

Acute vs. Chronic Presentation of Dacryoadenitis

A

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

27
Q

Dacryoadenitis diagnosis

A
  • Acute may require bacterial
    & fungal cultures
  • CT scan of the orbits
28
Q

Dacryoadenitis treatment

A
  • Viral self-limiting
  • Bacterial
  • Cephalexin (Keflex®)
  • Culture-directed
  • Treat any underlying conditions
  • Sarcoidosis, Sjogren Graves
29
Q

“Dry eye syndrome”

A

Keratoconjunctivitis Sicca

30
Q

What is this

A

Keratoconjunctivitis Sicca

31
Q

Often associated with Sjogren syndrome

A

Keratoconjunctivitis Sicca

32
Q

3 primary layers of the tear film

A

Lipid, Aqueous, & mucus (mucin)

33
Q

How can you see the exposed epithelium that occurs with dry eyes?

A

Damaged epithelial cells shed
* Visible via punctate staining when
the corneal surface is flooded with
fluorescein

34
Q

Keratoconjunctivitis Sicca diagnosis

A
  • Staining
  • Rose Bengal
  • lissamine green
  • Fluorescein staining
  • Schirmer test
35
Q

Schirmer test

A
  • Eyes are closed for 5 minutes
  • Measured in mm of moisture
    on filter paper
  • Normal = >10 mm
36
Q

Keratoconjunctivitis Sicca treatment

A
  • Prevent ulceration & scarring
  • Artificial tears
  • Drops, gels, ointments
  • Topical cyclosporine
  • Topical or systemic omega-3 fatty acids
  • Eye protection
37
Q

Blepharitis

A

Inflammation of the eyelid

38
Q

What is this called

A

Blepharitis - anterior

39
Q

Anterior blepharitis pathophysiology

A
  • Bilateral, chronic
  • Inflammation of eyelid margins
  • Staphylococcal
  • Seborrheic
  • Associated with seborrheic dermatitis
40
Q

Posterior Blepharitis pathophysiology

A
  • The result of meibomian gland dysfunction
  • Bilateral, chronic
41
Q

What is this?

A

Blepharitis - Posterior

42
Q

Blepharitis clinical presentation

A

Erythema, crusting, & matting of the lashes & lid margins

43
Q

Good eyelid hygiene

A

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

44
Q

Pinguecula

A

Small, yellow conjunctival growth

45
Q

Pinguecula pathophysiology

A
  • Hyperplasia of the conjunctival tissue
  • Environmental irritation
  • UV exposure
46
Q

What is this?

A

Pinguecula

47
Q

Pinguecula management

A
  • Observation
  • Minimize UV exposure
  • Topical steroid drops
48
Q

Pterygium

A

Fleshy, triangular encroachment of a pinguecula onto the cornea

49
Q

What is this

A

Pterygium

50
Q

Pterygium epidemiology

A
  • 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
51
Q

Clinical Presentation of Pterygium

A

Ranges from no symptoms to redess, swelling and blurred vision

52
Q

A _____ May grow over cornea &
block vision

A

Pterygium

53
Q

Pterygium Treatment

A
  • Observation, minimize UV exposure
  • Referral for removal
54
Q

Arcus Senilis

A

Bilateral white-gray peripheral ring

55
Q

T/F Arcus Senilis has No effect on vision

A

T

56
Q

Ptosis (Blepharoptosis)

A

Abnormal low-lying upper eyelid margin with the eye in primary gaze

57
Q

Congenital Horner’s Syndrome

A
  • Mild ptosis, miosis with ↓ iris pigmentation & heterochromia
  • Failure of development of the sympathetic
    nervous chain may be responsible
58
Q

Most common cause of ptosis

A

Improper levator muscle
development

59
Q

Entropion

A

Eyelid turns inward

60
Q

What is this called

A

Entropion

61
Q

Trichiasis

A

Misdirection of eyelashes toward the cornea
* Corneal irritation & encourages ulceration

62
Q

Ectropion

A

Eyelid turns outward

63
Q

What is this called

A

Ectropion

EENT Exam 1 (5 decks)

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