Eye 1 Flashcards

Question

FB under upper eye lid

Answer 1

-local anesthetic inserted -lid everted -FB removed with applicator -sterile wet cotton tipped applicator flips the upper lid

Answer 2

-corneal abrasions -h/o trauma to eye -fingernail, paper, contact lens -c/o pain, photophobia, tearing, blepharospasm, FB sensation -visual acuity recorded** -cornea and conjunctive examined- rule out FB -instill fluorescien-> examine with light -abrasion seen as darker green area -treatment- polymyxin-bacitracin ophthalmic ointment -mydriatic, analgesics -follow up in q24 hours till healing and referral

Answer 3

-surface epithelium sloughed off -stains with fluroescein -usually due to trauma -pain, FB sensation, tearing, red eye

Answer 4

-significant ocular trauma -typically form metallic object- hand tool -fingernail scratches- do not usually have enough force to lacerate cornea -c/o intense pain initially -may diminish slightly due to corneal desensitization -photophobia and profuse lacrimation -significant uveitis -anterior chamber shallow or even flat in full thickness laceration -intraocular pressure- ranges from 2-6 mmHg (normal- 10-21 mm Hg) -bubbles within the anterior chamber- key finding** -visual acuity significantly reduced -lens dislocation, iridodialysis, and hyphema

Answer 5

-collection of blood in anterior chamber -treatment of lacerations -referral to ophthalmologist ASAP -manipulation kept to a minimum- dont want to move them around -cover with shield lightly so nothing worse happens -pain mediations -keep NPO- in case of surgery -x-ray/CT done

Answer 6

-infection: -bacterial- adnexal infections, lid malposition, dry eye, CL -viral- HSV (dendritic ulcer), H. zoster Oticus -fungal- -protozoan- acanthamoeba in contact lens wearer -mechanical or trauma -chemical- alkali injuries are worse than acid -> irrigation!! -fern like- dendritic

Answer 7

-h/o blunt ocular trauma -usually caused by a large, low velocity object -intense pressure or swelling of the eye associated with nose blowing may also be reported -sports- related injuries are common -recent trauma- symptoms of pain, local tenderness and double vision -some patients- initially ignore treatment -may present long after the initial inflammatory manifestation have subsided -only relative enophthalmos (sunken in) and motility restriction, usually in upgaze and possible infraorbital hypoesthesia

Answer 8

-edema, ecchymosis of the lid tissues -restriction of ocular motility, espiecally with vertical movements -orbital crepitus (subcutaneous emphysema)- air under skin -hypoesthesia of the ipsilateral cheek- entrapment of the infraorbital nerve in foramen in undereye -orbital edema initially surrounds and displaces the globe -eye appears proptotic -as the swelling subsides- eye is likely to drop down and back, becoming enophthalmic -> sometime wait for this before surgery -associated traumatic uveitis and/or hyphema

Answer 9

-gloved finger along the under orbital bone -fingers drops down

Answer 10

-cover eye and restriction movement -all cases of blunt ocular trauma with resultant crepitus or motility restriction warrant orbital imaging studies -CT scan- procedure of choice -better at imaging the bony structures of the orbit than either plain skull films (x-ray) or MRI -obtain both axial and coronal scans -if floor fracture with associated herniation of the orbital contents -surgical intervention considered- wait 1014 days -recent trauma with significant diplopia in primary gaze or down gaze or unacceptable enophthalmos

Answer 11

-ophthalmic emergency -history of trauma -cover eye -NPO -closed global rupture- globe doesnt come out but it is under -open globe rupture- part of globe comes out

Answer 12

-any opacity of the lens -localize or diffuse -potentially causing problem with vision -usually develop slowly over years, but can rarely develop quickly over months -pathology of the lens (elasticity) - blurry vision or loss -may be unilateral or bilateral -most forms of cataracts do not affect both eyes symmetrically -90% of cataracts are age related -others- congenital, traumatic, metabolic, toxic, secondary, smoking, to another disorder

Answer 13

-with metal FB

Answer 14

-back of the eye vessels -not seen with cataracts -retina blastoma

Answer 15

-occur with aging -painless -other risk factors -trauma -smoking -alcohol -exposure to x-rays -heat from infrared exposure -systemic disease (diabetes) -uveitis -corticosteroids -chronic ultraviolet (UV) exposure possibly -congenital- associated with numerous syndromes and diseases

Answer 16

-loss of contrast -glare -needing more light to see well -problems distinguishing dark blue from black

Answer 17

-progressive -painlessty -blurring of vision -cataract can swell occluding drainage- secondary closed-angle glaucoma and pain (rare)

Answer 18

-degree of blurring depends on location and extent of opacity -nuclear cataract:* -central lens nucleus -myopia may develop in early stages, changing the refractive index of the lens so that presbyopic pt may be temporarily able to read without glasses (Second sight) -posterior subcapsular cataract:* -cataract beneath the posterior lens capsule -reduces visual acuity more when the pupil constricts (in bright light or during reading) -most likely to produce glare -loss of contrast

Answer 19

-Best with the pupil dilated -Well-developed cataracts -Gray or yellow-brown opacities in the lens -Examination of the red reflex through the dilated pupil discloses subtle opacities -Small cataracts -Stand out as dark defects in the red reflex -A large cataract may obliterate the red reflex -Slit-lamp examination provides more details about the character, location, and extent of the opacity

Answer 20

-UV coated eyeglasses or sunglasses -reducing risk factors -frequent refractions and corrective lens prescription changes- helps maintain useful vision -indirect lighting- optimizes vision -polarized lenses- decrease glare -indications for surgery: -maximally corrected vision < 20/40 (<6/12) -vision that is subjectively limiting, preventing needed or desired activities (driving, reading, other occupational activities)

Answer 21

-Posterior vitreous detachment -With age, the vitreous gel collapses and detaches from the retina -when the vitreous membrane pulls on and creates a tear in the retina -Vitreous fluid seeps into or underneath the retina -Detachment occurs from the pigmented epithelium underneath -Shower of floaters - These are thousands of blood cells being liberated from a tiny blood vessel which has been broken due to the tear (“shower of pepper”) -Descent of a “web” or “veil” in front of the eye or in the periphery -Permanent vision loss can result -Detachment needs to be repaired as soon as possible- Argon laser or “cryotherapy”

Answer 22

-Macular degeneration -Leading cause of irreversible blindness in the western world (>65) -Debris from light-absorbent molecules accumulates in cells in the back of the eye -Central part of the retina damaged; jeopardizing vision -Eventually unable to: Read, drive a car and even recognize familiar faces -AMD most common in later life -Now an increasing number of younger people are developing it

Answer 23

-“Dry” macular degeneration - caused by a thinning of the macula’s layers, and vision loss typically is gradual -“Wet” macular degeneration: -Tiny, fragile blood vessels develop underneath the macula -Results when these blood vessels hemorrhage, and destroy macular tissue -Vision loss can be rapid—over months or even weeks

Answer 24

-Earliest symptom - persistent blurred vision -Objects become distorted (straight lines become crooked) -Eventually, a small blind spot in the central visual field can develop and grow in size -This can progress to the point of “doughnut” vision, where people’s faces are unrecognizable when looking directly at them, yet peripheral vision remains unaffected **********************

Answer 25

-pts with visual loss not due to refractive error** should be referred to an ophthalmologist if the vision loss is associated with: -pain -marked redness -due to central retinal artery occlusion** -retinal detachment with good central vision -giant cell arteritis

Answer 26

-pts should be referred if vision loss* associated with: -redness -due to vitreous hemorrhage -retinal detachment -retinal vein occlusion -branch retinal artery occlusion -diabetic maculopathy -ischemic optic neuropathy -optic neuritis -sudden onset due to macular degeneration -occurs in association with thyroid eye disease