Eye 1 Flashcards
PTERYGIUM
general
slow-growing thickening of the
bulbar conjunctiva that may extend onto
the corneal surface
Pterygium
RF
Increased UV light exposure in sunny climates
Sand, wind, dust exposure
Pterygium
Clin Man
Clinical Manifestations
➤ Elevated, superficial fleshy, triangular-shaped growing fibrocartilage mass
➤ Usually starts medially and extends laterally
➤ Irritation, erythema, foreign body sensation
➤ Can impair vision
Pterygium
Tx
Observation, artificial tears
➤ Affected vision: surgical removal
➤ Recurrent pterygium may be more symptomatic and problematic to remove because of scarring
Pinguecula
general
slow growing thickening of the
bulbar conjunctiva that remains confined
to the conjunctiva
Pinguecula
RF
Eye irritation- dry, windy, sunny
conditions
Ocular trauma
Pinguecula
clin man
➤ Yellowish, slightly elevated nodule most commonly found in the nasal side of
the sclera
➤ Does NOT grow onto the cornea
Pinguecula
Tx
no Tx necessary
cosmetic: surgical resection
Hordeolum
General
➤ General: Localized abscess of the eyelid margin
➤ Increased risk with seborrheic dermatitis,
rosacea
➤ Internal or external
➤ Etiology: S. aureus
stye
Hordeolum
pathophys
Internal: inflammation or infection of a
meibomian gland found deep from the
palpebral margin under the eyelid
External: infection of an eyelash follicle or
external sebaceous gland near the lid margin
with production of pus in the gland of Moll or
Zeis
Hordeolum
Clin Man
Localized erythematous, painful, warm, tender nodule or pustule on the eyelid
Hordeolum
Tx
Mainstay and if persistent
➤ Mainstay: warm compresses
➤ May need incision and drainage or topical antibiotic ointment
➤ Erythromycin or bacitracin
Chalazion
general
General: painless indurated
granulomatous inflammation of the
internal meibomian sebaceous gland
away from the eyelid margin
Pathophysiology: obstruction of the Zeis
or Meibomian glan
Chalazion
Clin man
Nontender, localized edema and conjunctival nodule
Tend to be larger, firmer, slower growing, less painful than styes
Chalazion
Tx
Initial and refractory
➤ Eyelid hygiene, warm compresses
➤ Refractory: ophthalmology referral – may need glucocorticoid injection or incision
and curettage
Ectropian
RF and patho
Risk Factors:
➤ Elderly
➤ Associated with cranial nerve 7
palsy
➤ Can be congenital or infectious
Pathophysiology
➤ Relaxation of the orbicularis oculi
muscle
Ectropian
PE and Clin Man
Physical Exam Findings
➤ Eyelid and lashes are everted (turned outward)
Clinical Manifestations
➤ Irritation, ocular dryness, tearing, sagging of the eyelid, increased sensitivity
Ectropian
Tx
➤ Lubricating eyedrops, moisture shield
➤ Surgical correction if desired
Entropian
General
Risk Factors:
➤ Elderly
Pathophysiology
➤ Spasm of the orbicularis oculi muscle
Entropian
PE and Clin Man
Physical Exam Findings
➤ Eyelid and lashes are inverted (turned inward)
Clinical Manifestations
➤ Erythema, tearing, increased sensitivity
➤ Corneal abrasion or ulceration
Entropian
Tx
➤ Lubricating eyedrops, moisture shield
➤ Surgical correction if desired
Blepharitis
General
General: inflammation of the eyelid margin.
➤ Two types: anterior and posterior (most
common)
➤ Risk Factors
➤ Down syndrome, atopic dermatitis, rosacea,
seborrheic dermatitis
Blepharitis
patho
Pathophysiology
Anterior: Infectious or viral, S. aureus or S. epidermis, Seborrheic (most common)
Posterior: meibomian gland dysfunction
Blepharitis
Clin Man
Clinical Manifestations
Burning, erythema, crusting, scaling, red rimming of the eyelid, gritty sensation,
flaking on the lashes or lid margins
+/- entropion or ectropion
Blepharitis
Tx
➤ Eyelid hygiene – warm compresses, island scrub, gentle eyelid massage, artificial tears
➤ Baby shampoo, OccuSoft lid scrub
➤ Severe or refractory – topical or oral antibiotics, topical glucocorticoids
➤ Erythromycin, Azithromycin, Ofloxacin are most commonly used in practice
Dacrocystitis
General
General: infection of the lacrimal sac
➤ Chronic: caused by non infectious
inflammatory disorders such as
Sjorgren syndrome, thyroid disease
➤ Etiology: S. epidermis, S. aureus, GABHS,
Pseudomonas
➤ Pathophysiology: obstruction of the
nasolacrimal duct
Dacrryocystitis
Clin Man
Acute: tearing, tenderness, edema, erythema, warmth to the inferior medial
canthal side/lower lid area
May have purulent discharge
Chronic: Mucopurulent drainage from the puncta without other signs of infection
Dacryoocystitis
Tx
➤ Acute: oral antibiotics (Clindamycin) + warm compresses
➤ Chronic: dacrocystorhinostomy
Viral conjunctivitis
General
General: inflammation of the conjunctiva most
commonly caused by adenovirus
➤ Most common in children
➤ May have preceding/accompanying viral symptoms
➤ Transmission: direct contact
➤ Common source: swimming pools
Viral conjunctivitis
Clin Man
➤ Often bilateral
➤ Foreign body/gritty sensation, ocular erythema,
tearing with watery discharge , itching
➤ Normal vision
Viral conjunctivitis
PE
➤ Ipsilateral enlarged and tender preauricular lymphadenopathy
➤ Copious watery tearing
➤ Tarsal conjunctiva may have a follicular or bumpy appearance
Viral conjunctivitis
Tx
Supportive - warm/cool compresses, artificial tears, antihistamines (olopatadine)
BACTERIAL CONJUNCTIVITIS
general and Dx
General: inflammation of the conjunctiva
in response to bacterial infection
➤ Causative agents
➤ Adults: S. aureus
➤ S. pneumoniae, H. influenzae, M.
catarrhalis
➤ Contact lens: pseudomonas
➤ Diagnosis: clinical
bacterial conjunctivitis
Clin man
Clinical Manifestations
➤ Painless mucopurulent discharge, crusting, conjunctival erythema without ciliary
injection
➤ “My eyelids are crusted shut in the morning”
➤ Typically no vision change
Bacterial conjunctivitis
Tx
Topical antibiotics - erythromycin ointment, trimethoprim- polymixinB, ofloxacin
Contact lens use: ciprofloxacin, ofloxacin
Allergic conjunctivitis
general
inflammation of the conjunctiva in
response to contact with an allergen
Most common in children with atopy
Pathophysiology:
Type I(IgE) reaction causing local
mast cell degranulation and histamine
release
allergic conjunctivitis
clin man
Clinical Manifestations
➤ Conjunctival erythema, watery discharge, marked pruritis
➤ May have other allergic symptoms – nasal congestion, sneezing
➤ Normal vision
Cobblestone mucosa
Allergic conjunctivitis
PE
Cobblestone mucosa, watery stringy discharge, conjunctival edema
allergic coonjunctivitis
Tx
➤ Supportive measures with topical antihistamine (olopatadine, pheniramine-naphazoline)
Gonococcal conjunctivitis
general and complications
infection caused by the transmission of
neisseria gonorrhoeae by direct contact with
genital secretions
➤ Also known as Gonococcal ophthalmia
neonatorum in neonates
➤ Untreated cases can lead to meningitis and blindness
➤ Typically acquired during delivery, with
symptom onset of occurring in days 2–5
Gonococcal conjunctivitis
Dx
PCR, gram stain
gonococcal conjunctivitis
clin man
Clinical Manifestations
➤ Conjunctival injection, chemosis, eyelid edema
➤ Mucopurulent discharge
➤ Tenderness of globe
➤ Pre-auricular lymphadenopathy
Gonococcal conjunctivitis
Tx
➤ Prevention - erythromycin ophthalmic ointment
➤ Symptomatic - IM ceftriaxone or IM cefotaxime
Chlamydial conjunctivtis
general
General: infection caused by the
transmission of Chlamydia trachomatis
serotypes D-K via direct contact with
genital secretions
➤ Leading cause of preventable
blindness of infectious origin
➤ Incubation: 2-19 days
➤ Association with concurrent genital
infection
Chlamydial conjunctivitis
Dx
PCR, gram stain
Chlamydial conjunctivitis
CLin man
Clinical Manifestations
➤ Unilateral mucopurlent discharge, hyperemic tarsal conjunctiva
➤ Marked tarsal follicular response
➤ Pre-auricular lymphadenopathy
➤ Occasional superior corneal opacity and vascularization
Chlamydial conjunctivitis
Tx
Oral antibiotic – azithromycin or doxycycline
Treat partners as well
