Eye 1

Question 1

red eye - most common disease

Answer 1

conjunctivitis

Question 2

red eye - top priority

Answer 2

r/o vision threatening etiology

Question 3

Red eye History - include what (apart from standard OLDCARTS) 4

Answer 3

1. traumatic injury - blunt, penetrating, foreign body
2. exposures to chemicals, UV light, ocular meds
3. contact lens use
4. prior ocular surgeries

Question 4

red eye in h/p - red flags
5

Answer 4

1. severe ocular pain
2. persistently blurred vision
3. use of soft contact lenses
4. immunocompromised
5. neonate

Question 5

red eye - complete resolution of ocular pain w/ topical anesthetic is highly predictive of

Answer 5

superficial corneal etiology - i.e. corneal abrasion

Question 6

red eye physical exam red flags
8

Answer 6

1. afferent pupillary defect
2. ciliary flush
3. corneal opacity or lesion
4. elevated IOP
5. exophthalmos
6. painful eye movements
7. reduced ocular light reflex
8. visual acuity discrepancy

Question 7

red eye imaging/testing

Answer 7

none usually required in urgent care setting

Question 8

red eye DD
8

Answer 8

1. angle closure glaucoma
2. blepharitis - inflammation of eyelids
3. conjunctivitis
4. contact eye overuse
5. dry eye syndrome
6. hyphema - visible blood in anterior chamber of eye (emergency)
7. keratitis - inflammation of cornea
8. subconjunctival hemorrhage

Question 9

conjunctivitis definition

Answer 9

diffuse inflammation of bulbar and palpebral conjunctiva characterized by dilated conjunctiva blood vessels w/ chemosis (swelling of conjunctiva), hyperemia (dilated bv that make eye look red), and discharge

Question 10

conjunctivitis - what are characteristic for all etiologies (history)

Answer 10

hyperemia or injection, discharge or crusting, and foreign body sensation with acute onset

Question 11

conjunctivitis - which are almost always bilateral

Answer 11

viral
allergic

Question 12

bacterial conjunctivitis - bilateral or uni

Answer 12

most often uni

Question 13

which conjunctivitis - gritty foreign body sensation

Answer 13

viral

Question 14

which conjunctivitis - fever, pharyngitis, non purulent

Answer 14

adenovirus

Question 15

which conjunctivitis - purulent discharge that is profuse and continuous

Answer 15

bacterial

Question 16

children are more likely to have which conjunctivitis

Answer 16

bacterial

Question 17

conjunctivitis physical exam should include
4

Answer 17

1. visual acuity
2. penlight exam
3. evaluate for ulcers or vesicles (Hutchinson’s sign for VZV)
4. evaluate for foreign body or corneal lesion - lid eversion

Question 18

conjunctivitis - imaging/testing

Answer 18

none usually required in UC setting

Question 19

conjunctivitis - DD
4

Answer 19

1. blepharitis - inflammation of eyelids
2. dry eye syndrome
3. keratitis - inflammation of cornea
4. uveitis - inflammation of uvea

Question 20

conjunctivitis - itching, allergen exposure, water thick and stringy discharge, usually bilateral

Answer 20

allergic

Question 21

conjunctivitis - purulent discharge, foreign body sensation, usually unilateral

Answer 21

bacterial

Question 22

conjunctivitis - gritty foreign body sensation, recent URI or exposure to sick people, starts unilateral then becomes bilateral, watery discharge

Answer 22

viral

Question 23

allergic conjunctivitis - tx rx and f/u

Answer 23

Ophthalmic antihistamines - epinastine 1 gtt BID or azelastins 1 gtt BID
Ophthalmic mast cell stabilizer - cromolyn drop 1-2 gtt 4-6x day up to 2 weeks
PCP 1-2 weeks

Question 24

bacterial conjunctivitis - tx and f/u

Answer 24

topical antibiotics
PCP f/u if conditions persist or worsen

Question 25

viral conjunctivitis - tx and f/u

Answer 25

ocular lubricants +/- topical antihistamines

Question 26

allergic conjunctivitis rx

Answer 26

up to 2 weeks for topical antihistamine - epinastine 1 gtt Bid or azelastine 1 gtt BID Up to 2 week for mast cell stabilizer (prevents release of substances that cause inflammation) - cromolyn 2 gtt 4-6 x day

Question 27

bacterial conjunctivitis rx (3)

Answer 27

5-7 days ophthalmic abx (non contacts) - azithromycin ophthalmic (1 gtt BID x 2 days then 1 gtt qd) or erythromycin (1cm ribbon up to 6 x day) or polymyxin B/trimethoprim ophth abx (contacts) - ofloxacin or ciprofloxacin (1-2 gtt q2h while awake x two days then q4h)

Question 28

viral conjunctivitis rx (adenovirus)

Answer 28

up to 2 weeks of topical antihistamines - epinastine BID or azelastine

Question 29

non pharm remedies for bacterial conjunctivitis

Answer 29

artificial tears cold compresses hand hygiene d/c contacts until >24 hrs since last sx

Question 30

bacterial conjunctivitis - contact lens wearers rx info

Answer 30

warrants pseudomonas coverage w/ fluoroquinolones - 5-7 days of ofloxacin or ciprofloxacin

Question 31

periorbital cellulitis

Answer 31

infection of the periocular tissues anterior to orbital septum usually from local spread of rhinosinusitis or superimposed infection from trauma

Question 32

infection of the periocular tissues anterior to orbital septum usually from local spread of rhinosinusitis or superimposed infection from trauma

Answer 32

periorbital cellulitis

Question 33

periorbital cellulitis - most common orgs

Answer 33

S. aureus S. epidermidis Strep spp.

Question 34

periorbital cellulitis - more common in what age group

Answer 34

children

Question 35

periorbital cellulitis - hx and clinical presentation (1. recent what? 4 answers) 2

Answer 35

1. recent URI, trauma, insect bite, or hordeolum 2. fever

Question 36

periorbital cellulitis - physical exam 3

Answer 36

1. redness, swelling, tenderness or eyelid and surrounding tissue 2. spares tissue posterior to orbital septum 3. visual acuity, pupil reflexes, and extraocular movements intact w/o pain

Question 37

periorbital cellulitis - must consider orbital involvement if patient presents with 5

Answer 37

1. photophobia 2. pain with or impairment of extraocular movements 3. diplopia 4. proptosis 5. impaired vision

Question 38

periorbital cellulitis - img/testing 2

Answer 38

1. no img required if uncomplicated (i.e. no pain with extraocular movement, no photophobia, no concern for orbital involvement) 2. CT scan of orbits w/ contrast if concern for orbital involvement

Question 39

periorbital cellulitis - tx if uncomplicated 2

Answer 39

if uncomplicated send home on abx for 5-7 days 1. clindamycin 300 mg PO q8h OR 2. Bactrim DS PO q12 hrs + Augmentin PO BID or cefdinir 300 mg PO BID

Question 40

periorbital cellulitis - f/u

Answer 40

24-48 hours w/ Opth or PCP