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FPHCI- ENT > Eye > Flashcards

Eye Flashcards

1
Q

Eye Exam for Eye Complaint

A 
Inspect whole patient 
Visual acuity- each eye
Pupil reactions 
Lymphadenopathy- pre-auricular nodes
Eyelids
Conjunctiva (bulbar and palpebral) 
Cornea (clarity, staining with fluorescein, sensation)
Anterior chamber (depth)
Pupils shape/ reaction to light / accommodation
Funduscopic exam
Eye movements
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2
Q

Visual Acuity

OU
OD
OS

A 
Vital sign in occular complaints!!!
Test with glasses on
OU- Both
OD- Right
OS- Left eye
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3
Q

Common Causes of Red Eye

A

Conjunctivitis
Keratitis
Subconjunctival hemorrhage
Dry eye

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4
Q

Conjunctivitis

Name 5 types

Bacterial vs Viral?

A 
Most common eye complaint
Can be:
Viral, Bacterial, Fungal, Chemical, Allergic
Other …
Most cases benign & self-limiting
Bacterial or Viral?
Viral
Tends to be more in the summer
Itching common, minimal pain
Acute or subacute
Recent URI
Bacterial 
Tends to be more in winter/spring
Acute onset, minimal pain
Staph/Strep common
Discharge thick and purulent
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5
Q

Symptoms of Conjunctivitis

A 
Eyelids sticking
Itching/burning
Gritty
Pus
Recent URI
No change in visual acuity
Others with similar symptoms
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6
Q

Treatment of Conjunctivitis

3 types of medications

A

Usually supportive
Handwashing
Cold compresses
Antibiotic ointment/drops
Erythromycin ointment
1 cm in eye 4-6 times per day x 7-10 days
Polytrim
1 drop in eye 4-6 times per day x 7 – 10 days
Cipro drops (contact lens wearers)
1-2 drops in eye every 2 hours while awake x 2 days, then every 4 hours x 5 days

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7
Q

Chemical Conjunctivitis

A

Exposure to a chemical
Contact poison control
Flush eye – may need a Morgan’s Lens

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8
Q

Allergic Conjunctivitis

A

No pain, very itchy, may be acute/subacute
Clear, watery discharge
Treat with azelastine 0.05% - 1 drop BID

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9
Q

Conjunctivitis Teaching

A 
If no better or worse – REFER to ophthalmology
For any conjunctivitis
If chemical exposure
May need to go to ER or urgent care
If contact lens wearer
Always avoid wearing x 2 weeks
Change case, solution, & contacts
Also, change/discard any eye makeup
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10
Q

Bacterial Keratitis

A

VERY serious!! – Can lead to loss of vision
Complication of contact lens use
Pain, photophobia, decreased vision
Findings: corneal ulceration, upper eyelid edema, conjunctival hyperemia, adherent mucopurulent exudate, surrounding corneal inflammation
REFER, REFER, REFER – may need a corneal biopsy
Treatment – Specialized antibiotic drops and scheduling (every hour)

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11
Q

Subconjunctival Hemorrhage

Causes
Symptoms
Treatment

A

Bleeding from small vessels within the conjunctival vessels
Causes – trauma, coughing, sneezing, straining, HTN, blood thinners
Symptoms – no pain, normal vision, sudden onset of red eye
Treatment – reassurance, cold compress
Improves on own in 1-2 weeks
Always check blood pressure
If recurrent – consider bleeding disorder

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12
Q

Causes of Dry Eye

A 
Poor quality 
Meibomian gland disease, Acne rosacea
Lid related
Vitamin A deficiency
Poor quantity
Sjogren Syndrome
Rheumatoid Arthritis
Sarcoidosis
VII CN nerve palsy
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13
Q

Corneal Abrasion

A

Common eye injury
Usually without complications, but if severe can have long term consequences
Any defect in the epithelium of the cornea – injury, dust/debris, foreign body, burn, contact lens, etc.
Symptoms – pain, inability to open eye, foreign body sensation, photophobia, tearing, and conjunctival injection
Use wood’s lamp & fluorescein technique
Treatment – antibiotic ointment/drops, pain control
DO NOT GIVE PATIENT NUMBING AGENTS FOR HOME USE
Cipro drops for contact lens wearers
Patching not recommended or needed
Refer if large, retained foreign body, or deep corneal abrasion

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14
Q

Herpes Zoster Ophthalmicus

What cranial nerve?

Exam

Treatment

A

Shingles involving the trigeminal nerve (5)
Symptoms: eye pain, fever, malaise, headache, neck stiffness, unilateral eye redness, vision changes, tearing, rash
Exam: vesicular rash, lymphadenopathy, decreased visual acuity, iritis or keratitis
MAY LEAD TO VISION LOSS
Treatment: REFER to optho, Acyclovir 800 mg five times a day for 7-10 days, may need antibiotics if secondary infection, artificial tears, warm compresses, pain control

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15
Q

Acute Angle Closure Glaucoma

A

Diagnosis: Need 2 of the following:
Ocular pain, N/V, or intermittent blurring with halos
AND at least 3 of the following:
IOP > 21, conjunctival injection, corneal epithelial edema, mid-dilated nonreactive pupil, or shallow chamber in the presence of occlusion
May present with only headache or nausea/vomiting as main complaint
Causes: certain drugs, dim light, rapid correction of hyperglycemia
Exam: MUST include tonometry for evaluation of intraocular pressure (IOP)
REFER IMMEDIATELY to optho
Treatment includes: Acetazolamide IV/PO, topical beta blocker, topical steroid, may require surgery

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16
Q

Iritis/Uveitis

A

Inflammatory process – genetic, traumatic, immune, or infectious
Pain, redness, photophobia, blurred vision, tearing – can be acute or chronic
Injection all around the limbus (surrounds iris), decreased visual acuity
Bilateral or recurrent uveitis needs workup (not needed if mild case)
CBC, ESR, ANA, RPR, PPD, Lyme, HLA testing for AS, CXR, UA, and/or HIV
Should refer to optho and be seen within 24 hours
Treatment – treat underlying condition if believed to be the cause
Homatropine 5% - 1-2 drops in eye BID-TID
Topical steroids – should be started by optho only

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17
Q

Scleritis

Symptoms

Workup

Treatment

A

Usually from underlying autoimmune disease (RA, SLE, vasculitis, etc.)
Symptoms: pain, redness, tearing, photophobia, decreased visual acuity, may be unilateral or bilateral, usually chronic
Workup: RF, ANA, ANCA, HLA, IgE, Uric acid, ESR, HBsAg, RPR, Lyme, PPD – dependent on suspected cause
Treatment: NSAIDs, steroids, or immunomodulatory drugs
Primary care – generally oral prednisone or ibuprofen until referred
Refer to optho or rheumatology

18
Q

Myopia

A

Nearsighted- unable to see object far away

19
Q

Hyperopia

A

Farsightedness- unable to see objects up close

20
Q

Astigmatism

A

Objects appear blurry and stretched out

21
Q

Presbyopia

A

Age related condition, unable to focus objects clearly

22
Q

Cataracts

Risk Factors

Symptoms

Treatment

A

Opacifications of the lens of the eye
Risk factors – older age, females, use of corticosteroids, systemic disease (DM), smoking, UV exposure
Symptoms – decreased visual acuity, decreased color perception, decreased contrast sensitivity, issues with glare
Treatment – change in eyewear prescription, smoking cessation, UV protection, use of good lighting, surgical treatment

23
Q

Glaucoma

Definition
Risk factors
Symptoms
Treatment

A

Increased intra-ocular pressure – chronic illness
Risk factors – family history, age over 40, AA race
Symptoms – slow progression of peripheral vision with decreased central visual acuity, difficulty with dim light, decreased contrast sensitivity, difficulty with glare, decreased dark/light adaptation
Early diagnosis/treatment is important to prevent vision loss
Treatment – topical medications including prostaglandins, beta blockers, adrenergics, carbonic anhydrase inhibitors, miotics, oral medication, laser therapy
Usually followed by optho

24
Q

Tonometry

A

Must calibrate prior to each use.
Normal reading under 20mm/Hg
Record OU

25
Q

Open-angle glaucoma causes

A

May have genetic links; environmental factors may also induce glaucoma; close association with DM

26
Q

Closed-angle glaucoma

Causes

A

Common medications- Sulfa-containing meds, Corticosteroids, Cholinergic agents (Pilocarpine), Adrenergic agonists (Albuterol), Antidepressants ACE inhibitors (rare)

27
Q

Congenital glaucoma

A

Presentation of disease within first year of life; usually indicative of a genetic anomaly

28
Q

Juvenile-onset glaucoma

A

Seen in children ages 5-18; usually caused by genetic factors

29
Q

Secondary glaucoma

A

Caused by trauma, inflammation and ischemia to the eye

30
Q

Glaucoma screening

A

Every 3-5 years for 40-60 year olds without risk factors
> 60 years old every 1-2 years
No specific screening guidelines per the U.S. Preventative Task Force
Be aware of patients at higher risk for developing glaucoma, will need more frequent screening

31
Q

Glaucoma risk factors

A

Open-Angle: European/ African American
Closed-Angle: Asian descent, Inuit descent and patients with shallow anterior chambers
Lower socioeconomic factors at higher risk for vision loss
Male babies/children at higher risk for developing congenital form
Family history of glaucoma
Diabetes
Female

32
Q

Diabetic Retinopathy

A

Complication of diabetes, increases with duration of disease
Two types – nonproliferative & proliferative – differentiated by exam findings
Nonproliferative can develop into proliferative
Early treatment/control can prevent retinopathy and vision loss
Symptoms – decreased visual acuity, contrast sensitivity, color perception, & dark/light adaptation, also have issues with glare and distortion
Annual eye exam for ALL patients with diabetes (Type I & II)
Treatment – may need laser surgery

33
Q

Macular Degeneration

A

Can be dry or wet
DRY – deposits & areas of depigmentation alternating with hyperpigmentation
WET – Neovascularization
Initially no symptoms then progress to loss of central vision with metamorphopsia (distortion of objects), glare sensitivity, decreased contrast sensitivity, decreased color vision
Risk factors – older age, smoking, HTN, hyperlipidemia, vascular insufficiency, UV light exposure, family history
Should be followed by optho
Treatment – Vitamin C, Vitamin E, beta carotene, zinc, control risk factors, exercise, sunglasses

34
Q

Retinal Detachment

A

Causes – trauma, history of previous eye surgery, vascular disease, tumor, degeneration, metabolic disorders, other
Symptoms – flashes of light, visual field defect, floaters, cloudy vision, curtain-like vision
REFER immediately to optho – may need immediate surgery – specifically may need retinal specialist
Can lead to loss of vision or permanent visual defect

35
Q

Blepharitis

A

Inflammatory disease of the eyelid
Symptoms – eye irritation, itching, lid redness, flaking, eyelash changes, burning, watering, crusting, red eyes, decreased vision, pain, photophobia, foreign body sensation
Exam – Eyelid redness & crusting of lids/lashes
Related to seborrheic dermatitis & rosacea
Treatment – eyelid hygiene with warm compresses, baby shampoo, antibiotic ointment (ophthalmic), if refractory may need oral ABX (tetracycline)
Usually a chronic condition

36
Q

Hordeolum

A 
Hordeolum (Stye)
Painful lump
Base of eyelash
Usually bacterial
Warm compresses & antibiotic drops/ointment
Acute problem
Resolves in 1-2 weeks
37
Q

Chalazion

A 
Chalazion
Swollen bump on eyelid
Usually non-painful
Clogged oil gland
Warm compresses
May need steroid shots
May require surgery
Chronic in nature
38
Q

Orbital cellulitis

A

Cellulitis of orbital tissue – may lead to infection of eye and vision loss
Symptoms – fever, malaise, history of recent URI/sinusitis, headache, lid edema
Exam – redness, warmth, swelling, pain with eye movement, orbital pain
Workup – CBC, Blood culture, culture if drainage, CT if severe to eval for abscess
Treatment – may require hospitalization (severe), drainage of abscess if present, refer to optho
ABX – clindamycin 300 mg four times daily x 10 days or Bactrim DS BID x 10 days

39
Q

Traumatic Hyphema

A

Blood in the anterior chamber of the eye
Usually the result of trauma, but can also be from eye surgery or medical issue
ALWAYS REFER ASAP
Must evaluate for more serious eye injury
Symptoms – eye pain, blurred or loss of vision, photophobia
Exam – Examine sitting and lying back – may change position of blood
Treatment – bed rest, elevate head, protect eye, treat elevated IOP if present, may require surgery

40
Q

Orbital Fracture

A

Traumatic injury – assault, MVA, fall, sports injury, etc.
Several different types of fractures – type dictates management
CT to determine type of fracture & to eval globe
Evaluate for – injury to the globe & muscle entrapment, visual disturbances, nerve injuries
Treatment – avoid nose blowing & Valsalva maneuvers, oral ABX, pain control, keep head elevated, may require surgery
Refer – may need ENT, plastics, maxillofacial, or ophthalmology

41
Q

Orbital hematoma/Globe Rupture

A

Both are optho emergencies and require immediate referral – both from blunt trauma
Globe rupture is a full-thickness injury to cornea, sclera, or both
Orbital hematoma or compartment syndrome – severe pressure from collection of blood
Treatment – lateral canthotomy
Symptoms – pain, loss of vision, swelling, other symptoms related to mechanism of injury
Globe rupture – do not apply any pressure to eye, leave foreign bodies in place, DO NOT measure IOP, DO NOT instill anything into eye (medication, flush, etc.)
CT to evaluate

42
Q

Pterygium

A

Also known as “surfer’s eye”
Growth of fleshy tissue and can cover cornea
Cause – dry eye, exposure to wind, dust, UV light
Symptoms – burning, itching, tearing, visual disturbance
Treatment – sunglasses, eye protection, artificial tears, surgery if severe

FPHCI- ENT (3 decks)

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