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EENT > Eye > Flashcards

Eye Flashcards

1
Q

Anisocoria

A

uneven pupil size, not necessarily pathological

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2
Q

During physical exam what do you do first?

A

Visual acuity THEN fundoscopic

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3
Q

when to refer with red eye

A

associated w/ pain, visual disturbance, corneal damage, glaucoma, FB

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4
Q

What should you NEVER Rx for Red eye?

A

steroids - it could worsen problem and cause corneal ulcer -> perforation

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5
Q

Bacterial Conjunctivitis

A 
red eye w/ mucopurulent discharge 
U/L
crusty eyelids (especially in morning)

Strep pneumoniae (temperate zone), Staph aureus, H influenzae
H aegyptius (tropical zone)
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6
Q

Severe hyperacute bacterial conjunctivitis

A

Neisseria gonorrhea -> may scar or perforate cornea leading to systemic infection
will have gross purulence

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7
Q

Chronic bacterial conjunctivitis

A

Staph aureus & Moraxella lacunata

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8
Q

Chlamydial bacterial conjunctivitis

“trachoma”

A

B/L “inclusion conjunctivitis”
w/ prominent follicular conjunctival response and pre auricular adenopathy
profuse exudate

trachoma is major cause of blindness

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9
Q

Viral conjunctivitis

A

watery (sometimes mucoid) discharge
U/L spreading to B/L few days later
preauricular adenopathy

associated w/ fever, pharyngitis (especially in children)

etiology: adenovirus

highly contagious

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10
Q

Allergic conjunctivitis

A

associated w/ seasonal allergies, atopic dermatitis, rhinorrhea (thin and clear) and nasal congestion

B/L itching and tearing (clear)

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11
Q

B/L sterile conjunctival inflammation

A

occurs in pts w/ acne rosacea, Reiter’s syndrome (HLAB27) , and Stevens Johnsons Syndrome

associated w/ reactive arthritis

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12
Q

Hypersensitivity -> Red Eye

A

sensitivity to eye Rx, makeup (could be an allergic response)
erythema of external lids
angioneurotic edema B/L allergic response to systemic allergen
angioneurotic edema U/L allergic response to local allergen (poison ivy, insect bite)

Edema W/O erythema suggests allergy NOT infection

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13
Q

Pinguecula -> Red Eye

A

yellow white, harmless nodule of sclera conjunctiva
usually on nasal side
d/t heavy exposure to UV light

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14
Q

Pterygium -> Red Eye

A

wing shaped fibrovascular conjunctival tissue growth and redness
could encroach on cornea impairing vision
d/t heavy exposure to UV light

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15
Q

Subconjunctival Hemorrhage -> Red Eye

A

associated w/ minor trauma
could be systemic (impaired clotting and venous congestion)
could occur with anticoagulant use
Focal or diffuse patch of redness W/O discharge or itching

Massive hemorrhage leading to proptosis and limited EOM signals orbital hemorrhage

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16
Q

Foreign Body -> Red Eye

A

copious tearing, conjunctival injection, sensation that something got “into” eye

occasionally eye tolerates FB and eye is white and quiet

Tx: vigorous irrigation and REFER

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17
Q

Episcleritis -> Red Eye

A

benign inflammation of the superficial episclera vessels
if recurrent conjunctiva manifests circumscribed nodular inflammation (mildly tender red eye)
conjunctiva will show local raised areas of redness

VISION AND LIDS ARE NORMAL

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18
Q

Keratitis -> Red Eye

A

inflammation of the cornea
presents w/
perilimbal ciliary flush w/ tearing and photophobia

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19
Q

Corneal ulcer -> Red Eye

A

detect w/ fluorescein staining
focal area of haze or opacification of cornea visible

“dendritic” figure of herpes simplex keratitis
Staph aureus may cause sterile infiltrate in corn lea limbus

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20
Q

Corneal abrasion -> Red Eye

A

usually d/t minor trauma (fingernail, contacts, small FB)
could result in hyphen
pain, FB sensation, photophobia, tearing, injection, blepharospasm
record visual acuity before exam
fluorescein stain will reveal epithelial defect but clear cornea
FB search required

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21
Q

Hyphema -> Red Eye & Impaired Vision

A

blood layering in anterior chamber
REFER
opacity d/t RBCs

22
Q

Corneal laceration w/ perforation -> Red Eye

A

shallow or absent anterior chamber
decreased IOP, eccentric pupil, iris prolapse into wound
Tx: EMERGENCY

23
Q

Uveitis -> Red Eye

A

inflammation of the uveal tract including iris, ciliary body, choroid

24
Q

Iritis -> Red Eye & Impaired Vision

A

anterior uveitis
presents w/
eye pain, photophobia, redness, pupillary contraction, ciliary flush, decreased vision

U/L or B/L
IF U/L affected pupil smaller b/c of iris spasm
Flashlight exam shows slightly cloudy anterior chamber

opacity d/t inflammatory cells

25
Uveal Tract Dz -> Red Eye
idiopathic | associated w/ anklosing spondylitis, juvenile rheumatoid arthritis, sarcoidosis
26
Blepharitis -> Red Eye
inflammation of the structures of the lid margin presents w/ lid margin redness, scaling, crusting Staph blepharitis produces dry scales, lash loss, and conjunctivitis and corneal limbal infiltrates Seborrheic blepharitis and meibomian gland dysfunction associated w/ chronic oily secretions causing irritation and dilated vessels w/ conjunctiva inflammation meibomian gland dysfunction associated w/ seborrheic dermatitis and acne rosacea
27
Hordeolum -> Red Eye
acute inflammatory or infectious nodule of meibomian glands (internal) or the glands of Zeis (external or stye) presents w/ red, tender mass near lid margin may produce superficial lid infection -> preseptal cellulitis
28
Chalazion -> Red Eye
sterile chronic granulomatous inflammation of the gland of Zeis or meibomian gland may be tender and mildly inflamed OR quiet discrete mass
29
Acute Dacryocystitis -> Red Eye
localized infection of the tear duct and/or lacrimal sac | presents w/ focal tenderness to palpation and expression of purulent material from tear duct when pressure is applied
30
Orbital Cellulitis -> Red Eye & Exophthalmos
presents w/ swollen, red eyelids with chemises, exophthalmos, pain, fever, leukocytosis may lead to paresis of the 3rd, 4th, 6th CNs or ophthalmic division of 5th CN which are signs of cavernous onus thrombosis orbital infection can result from sinusitis
31
Acute glaucoma -> Red Eye & Impaired Vision
OCULAR EMERGENCY painful red eye w/ prominent ciliary flush pupil is mid dilated and fixed and cornea is cloudy secondary to edema IOP exceeds 40 mm Hg pt reports cloudy vision, colored rings around lights, U/L HA w/ N/V d/t angle closure in eyes w/ susceptible narrow angles visual loss is gradual and progressive peripheral vision loss, central vision intact until late in the dz
32
Refractive Error -> Impaired Vision
most common cause of decreased visual acuity inability for eye to focus light on retina myopia most common error Presbyopia in pts > 40 d/t can't accommodate to near distances and require reading glasses Early cataract can increase myopia b/f they opacify and block transmission of light uncontrolled diabetes can produce swelling of lens and myopia (myopia resolves when DM resolved) Drugs can induce myopia
33
Impaired Vision
decreasing or blurred vision REFER sudden visual loss EMERGENCY
34
Cataracts -> Impaired Vision
opacification of the lens | leading cause of gradual vision loss in elderly
35
Vitreous opacification -> Impaired Vision
occurs most often from hemorrhage and less commonly from inflammation or infection vitreous hemorrhage could be d/t diabetic retinopathy, retinal tear or detachment, trauma, HTN, sickle cell retinopathy, or clotting abnormalities vitreous floater may transiently blur vision
36
Age related Macular Degeneration -> Impaired Vision
leading cause of legal blindness in pts older then 55 | central vision is impaired, peripheral vision intact
37
Retinal Inflammation -> Impaired Vision
could be d/t histoplasmosis, toxoplasmosis, cytomegalovirus, herpes virus infections If d/t CMV in HIV (immunocomprimised pts) then want to catch early and treat decreases vision
38
Trauma -> Impaired Vision
decreased visual acuity by producing macular edema (visual acuity resolves) or a choroidal rupture (permanent decrease in visual acuity)
39
Retinal detachment -> Impaired Vision
decreased visual acuity flashing lights and shower of vitreous floaters presage a detachment detachment is like a "shade being drawn"
40
central retinal artery occlusion -> Impaired Vision
sudden painless profound loss of vision to hand movements or no light perception pale optic disc, attenuated arterioles, "boxcar" veins, hazy edematous edema, cherry red spot in macula occasionally an embolus may be seen at a bifurcation of a retinal arteriole most common embolic sources are an atheromatous plaque in the ipsilateral carotid artery or a vegetation from a cardiac valve leaflet
41
giant cell (temporal) arteritis -> Impaired Vision
a granulomatous inflammation of the medium and large arteries in elderly can cause sudden visual loss swollen or normal optic disc, or central retinal artery occlusion
42
optic neuritis -> Impaired Vision
inflammation of the optic nerve presents w/ acute impairment of vision in 15-40 y/o usually idiopathic but 20-50% develop multiple sclerosis progressive U/L loss of vision over hours to days pain on eye motion afferent pupillary defect, globe tenderness, visual field defects, impairment of color vision
43
Infiltrative or compressive lesions of the optic nerve -> Impaired Vision
pituitary adenomas, meningiomas, gliomas, internal carotid artery aneurysms all cause gradual vision loss these lesions are anterior to the optic chiasm U/L lesion -> homonymous hemianopsia B/L lesion -> profound vision loss
44
Psychopathology -> Impaired Vision
hysteria and malingering subjective vision loss objective eye exam and other measure intact "its all in their head"
45
Exophthalmos
protrusion or proptosis of the eye | could be normal or a sign of systemic or orbital dz
46
Graves Dz -> Exophthalmos
an autoimmune inflammatory process leading to infiltration of the soft tissues of the orbit Risk factors -> smoking, hyperthyroidism mild form -> minor lid retraction, stare, lid lag, mild protrusion of the eye (proptosis)
47
Primary Orbital Neoplasm -> Exophthalmos
meningiomas produce exophthalmos by mass effect hemangiomas produce only a mass effect carotid cavernous sinus fistula presents w/ a diffusely congested orbit w/ exophthalmos, prominent episcleral vessels, and elevated IOP mass lesions and vascular abnormalities are U/L -> diplopia, ocular irritation, and photophobia
48
Diabetic Retinopathy
leading cause of blindness in pts < 65 y/o | preventable, treatable, asymptomatic
49
Nonproliferative Diabetic Retinopathy
early stage intraretinal vascular damage changes result in dilation of small vessels and vascular closure leading to ischemia retinal capillaries become permeable to water, lipids, and large molecules resulting in micro aneurysms, intraretinal hemorrhages, cotton wool infarctions, and lipid and serous exudates leading to retinal edema pts are asymptomatic unless retinal edema or ischemia involves central macula macular edema causes blurring or distortion followed by central vision loss macular edema is the leading cause of visual loss in diabetics
50
Proliferative Diabetic Retinopathy
later stage -> worse prognosis abnormal vascular proliferation (neovascularization) originating in the retina and extending into the vitreous cavity as widespread retinal ischemia occurs, vasoproliferative factors trigger neovascularization resulting in dense white fibrotic tissue adhering to the posterior vitreous this tissue can contract and pull the vitreous anteriorly causing the vessels to rupture -> vitreous hemorrhage the tissue can also elevate the retina -> retinal detachment when neovascularization occurs on the iris neovascular glaucoma can occur neovascularization = fine network of small vessels proliferating from optic disc, the major retinal vessels, or areas adjacent to retinal ischemia
51
Retionopathy -> when to refer
change in vision, new floaters, eye pain, upon discovery of retinoapthy, loss of ability to visualize fundus
52
Hypertensive Retinopathy
On exam: arterial-venous nicking, arteriolar narrowing, increased vascular tortuosity, flame hemorrhages

EENT (3 decks)

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