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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
1 in 10,000 ophthalmic patients will have this
Dacryoadenitis
24
Inflammatory enlargement of the lacrimal gland
Dacryoadenitis
25
What is this
Dacryoadenitis
26
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
27
Dacryoadenitis diagnosis
* Acute may require bacterial & fungal cultures * CT scan of the orbits
28
Dacryoadenitis treatment
* Viral self-limiting * Bacterial * Cephalexin (Keflex®) * Culture-directed * Treat any underlying conditions * Sarcoidosis, Sjogren Graves
29
“Dry eye syndrome”
Keratoconjunctivitis Sicca
30
What is this
Keratoconjunctivitis Sicca
31
Often associated with Sjogren syndrome
Keratoconjunctivitis Sicca
32
3 primary layers of the tear film
Lipid, Aqueous, & mucus (mucin)
33
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
34
Keratoconjunctivitis Sicca diagnosis
* Staining * Rose Bengal * lissamine green * Fluorescein staining * Schirmer test
35
Schirmer test
* Eyes are closed for 5 minutes * Measured in mm of moisture on filter paper * Normal = >10 mm
36
Keratoconjunctivitis Sicca treatment
* Prevent ulceration & scarring * Artificial tears * Drops, gels, ointments * Topical cyclosporine * Topical or systemic omega-3 fatty acids * Eye protection
37
Blepharitis
Inflammation of the eyelid
38
What is this called
Blepharitis - anterior
39
Anterior blepharitis pathophysiology
* Bilateral, chronic * Inflammation of eyelid margins * Staphylococcal * Seborrheic * Associated with seborrheic dermatitis
40
Posterior Blepharitis pathophysiology
* The result of meibomian gland dysfunction * Bilateral, chronic
41
What is this?
Blepharitis - Posterior
42
Blepharitis clinical presentation
Erythema, crusting, & matting of the lashes & lid margins
43
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
44
Pinguecula
Small, yellow conjunctival growth
45
Pinguecula pathophysiology
* Hyperplasia of the conjunctival tissue * Environmental irritation * UV exposure
46
What is this?
Pinguecula
47
Pinguecula management
* Observation * Minimize UV exposure * Topical steroid drops
48
Pterygium
Fleshy, triangular encroachment of a pinguecula onto the cornea
49
What is this
Pterygium
50
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
51
Clinical Presentation of Pterygium
Ranges from no symptoms to redess, swelling and blurred vision
52
A _____ May grow over cornea & block vision
Pterygium
53
Pterygium Treatment
* Observation, minimize UV exposure * Referral for removal
54
Arcus Senilis
Bilateral white-gray peripheral ring
55
T/F Arcus Senilis has No effect on vision
T
56
Ptosis (Blepharoptosis)
Abnormal low-lying upper eyelid margin with the eye in primary gaze
57
Congenital Horner’s Syndrome
* Mild ptosis, miosis with ↓ iris pigmentation & heterochromia * Failure of development of the sympathetic nervous chain may be responsible
58
Most common cause of ptosis
Improper levator muscle development
59
Entropion
Eyelid turns inward
60
What is this called
Entropion
61
Trichiasis
Misdirection of eyelashes toward the cornea * Corneal irritation & encourages ulceration
62
Ectropion
Eyelid turns outward
63
What is this called
Ectropion

EENT Exam 1 (5 decks)

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