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Urgent Care Guide > Eye 1 > Flashcards

Eye 1 Flashcards

1
Q

red eye - most common disease

A

conjunctivitis

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2
Q

red eye - top priority

A

r/o vision threatening etiology

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3
Q

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

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

red eye in h/p - red flags
5

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

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

A

superficial corneal etiology - i.e. corneal abrasion

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6
Q

red eye physical exam red flags
8

A
  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
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7
Q

red eye imaging/testing

A

none usually required in urgent care setting

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8
Q

red eye DD
8

A
  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
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9
Q

conjunctivitis definition

A

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

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10
Q

conjunctivitis - what are characteristic for all etiologies (history)

A

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

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11
Q

conjunctivitis - which are almost always bilateral

A

viral
allergic

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12
Q

bacterial conjunctivitis - bilateral or uni

A

most often uni

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13
Q

which conjunctivitis - gritty foreign body sensation

A

viral

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14
Q

which conjunctivitis - fever, pharyngitis, non purulent

A

adenovirus

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15
Q

which conjunctivitis - purulent discharge that is profuse and continuous

A

bacterial

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16
Q

children are more likely to have which conjunctivitis

A

bacterial

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17
Q

conjunctivitis physical exam should include
4

A
  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
18
Q

conjunctivitis - imaging/testing

A

none usually required in UC setting

19
Q

conjunctivitis - DD
4

A
  1. blepharitis - inflammation of eyelids
  2. dry eye syndrome
  3. keratitis - inflammation of cornea
  4. uveitis - inflammation of uvea
20
Q

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

A

allergic

21
Q

conjunctivitis - purulent discharge, foreign body sensation, usually unilateral

A

bacterial

22
Q

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

A

viral

23
Q

allergic conjunctivitis - tx rx and f/u

A

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

24
Q

bacterial conjunctivitis - tx and f/u

A

topical antibiotics
PCP f/u if conditions persist or worsen

25
Q

viral conjunctivitis - tx and f/u

A

ocular lubricants +/- topical antihistamines

26
Q

allergic conjunctivitis rx

A

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

27
Q

bacterial conjunctivitis rx (3)

A

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)

28
Q

viral conjunctivitis rx (adenovirus)

A

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

29
Q

non pharm remedies for bacterial conjunctivitis

A

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

30
Q

bacterial conjunctivitis - contact lens wearers rx info

A

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

31
Q

periorbital cellulitis

A

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

32
Q

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

A

periorbital cellulitis

33
Q

periorbital cellulitis - most common orgs

A

S. aureus
S. epidermidis
Strep spp.

34
Q

periorbital cellulitis - more common in what age group

A

children

35
Q

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

A
  1. recent URI, trauma, insect bite, or hordeolum
  2. fever
36
Q

periorbital cellulitis - physical exam
3

A
  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
37
Q

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

A
  1. photophobia
  2. pain with or impairment of extraocular movements
  3. diplopia
  4. proptosis
  5. impaired vision
38
Q

periorbital cellulitis - img/testing
2

A
  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
39
Q

periorbital cellulitis - tx if uncomplicated
2

A

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

40
Q

periorbital cellulitis - f/u

A

24-48 hours w/ Opth or PCP

Urgent Care Guide (38 decks)

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