EYE Flashcards
Bacterial Conjunctivitis
- What is it:
“inflammation of the conjunctival tissue, engorgement of blood vessels, pain, ocular discharge
can be chronic or acute and infectious or non-infectious”
- Etiology/Pathogens:
s. aureus, s. pneumoniae, h. influenza, c. trachomatis
- Epidemiology:
december to april peak, more prevalent in children
- Pathophysiology:
“transmission of pathogens into the conjunctiva either of bacterial or viral origin
in allergic an allergen has contact with the ocular surface”
- Signs:
purulent discharge, may be unilateral, conjunctival injection
- History/Symptoms:
typically exposed from someone else, not washing hands
- Evaluation:
“chlamydial - giemsa stain
neisseria - gram stain”
- Treatment:
“0.5 inch of ointment deposited inside the lower lid or 1-2 drops instilled 4x a day for 5-7 days
erythromycin opthalmic ointment
trimethoprim and polymyxin B”
- Patient Education:
wash hands, stop wearing contact lenses, safe sex (if STI), transmission prevention
Viral Conjunctivitis
- What is it:
“inflammation of the conjunctival tissue, engorgement of blood vessels, pain, ocular discharge
can be chronic or acute and infectious or non-infectious”
- Etiology/Pathogens:
adenovirus, herpes simplex, herpes zoster, enterovirus
- Epidemiology:
usually in older children
- Pathophysiology:
“transmission of pathogens into the conjunctiva either of bacterial or viral origin
in allergic an allergen has contact with the ocular surface”
- Signs:
watery discharge, scant mucoid discharge, could be concurrent with an URI, preauricular lymphadenopathy
- History/Symptoms:
swimming in pools can expose to adenovirus
- Evaluation:
clinical evaluation diagnosis, but can use adenovirus tests
- Treatment:
topical antihistamines or decongestants, warm or cool compresses, artificial tears
- Patient Education:
washing hands to prevent transmission
- What is it:
- Etiology/Pathogens:
- Epidemiology:
- Pathophysiology:
- Signs:
- History/Symptoms:
- Evaluation:
- Treatment:
- Patient Education:
Cataract
- What is it:
Clouding, opacification of the normally clear lens, can be bilateral and vary in severity
- Etiology/Pathogens:
congenital, age-related, subcapsular (fibrous metaplasia), nuclear sclerotic, cortical, trauma, systemic diseases (myotonic, atopic dermatitis, neurofibromatosis type 2)
- Epidemiology:
“white > black > hispanic
typically onset in 40-50s
more common in women”
- Pathophysiology:
lens is made up of the cortex (superficial) and nucleus (deeper), degenerative processes denature and coagulate lens proteins
- Signs:
decreased visual acuity, opacification of lens
- History/Symptoms:
decrease or blurring vision, diplopia or polyplopia, colored halos around light, sensitivity to glare, increased frequence of changing glasses, disturbance in color vision
- Evaluation:
visual acuity, cover and uncover test, pupillary response
- Treatment:
“*lifestyle changes: glasses, brighter lights, anti-glare sunglasses
*pupillary dilatation with 2.5% phenylephrine
* cataract surgery”
- Patient Education:
using visual acuity charts on a regular basis, wear spectacles in sunlight to avoid UV damage, systemic evaluation to rule out any systemic cause, refer to opthalmology
Scleritis
- What is it:
inflammation of the sclera, categorized as diffuse, nodular, or necrotizing, unilateral or bilateral
- Etiology/Pathogens:
“idiopathic, infectious, noninfectious
50% of patients will have an autoimmune condition, sometimes undiagnosed, commonly rheumatoid arthritis and systemic vasculitic conditions”
- Epidemiology:
middle age (47-60), more common in women
- Pathophysiology:
pathophys isn’t well understood, extracellular matrix is similar to that of joints which makes it susceptible in patient with rheumatoid arthritis
- Signs:
ocular redness, pain on palpation of eyeball, visual impairment, no vessel blanching with phenylephrine, blue violet hue of deep vessels
- History/Symptoms:
significant eye pain, worse at night, pain with eye movement, photophobia, tearing
- Evaluation:
clinical presentation and ocular exam also need to screen for systemic disease that could be causing the scleritis
- Treatment:
“*refer to opthalmologist
*topical corticosteroid eyedrops
*oral NSAIDs”
- Patient Education:
explain risk of associated systemic conditions, pain management and control of inflammation
Allergic Conjunctivitis
- What is it:
“inflammation of the conjunctival tissue, engorgement of blood vessels, pain, ocular discharge
can be chronic or acute and infectious or non-infectious”
- Etiology/Pathogens:
often secondary to other allergic reactions such as rhinitis
- Epidemiology:
spring and summer peak, onset in those younger than 20 and decreases in old age
- Pathophysiology:
“transmission of pathogens into the conjunctiva either of bacterial or viral origin
in allergic an allergen has contact with the ocular surface”
- Signs:
itching, tearing, cobblestone mucosa, other allergic symptoms
- History/Symptoms:
recurrent episodes, history of allergies
- Evaluation:
clinical evaluation diagnosis, can use fluorescein staining to rule out abrasion can also use conjunctival scraping to examine eosinophils
- Treatment:
systemic or topical antihistamines or mast cell stabilizers, NSAIDS
- Patient Education:
identifying allergen and avoiding it, informing patients about effectiveness of antihistamine treatment and why to adhere
Keratitis
- What is it:
inflammation of the cornea from infection, injury, autoimmune, dry eye, or others
- Etiology/Pathogens:
“viral: HSV and dendritic ulcer
bacterial: s. aureus, p.aeruginosa, aka corneal ulcer”
- Epidemiology:
contact lens wearing is a significant indicator, farmers are at high risk, fungal common in developing nations
- Pathophysiology:
recruitment of leukocytes and macrophages as a response to infiltration of a pathogen
- Signs:
recent topical corticosteroids, lacrimal duct patency or regurgitation, corneal opacity or infiltrate (round white spot)
- History/Symptoms:
redness, pain, irritation, photophobia, visual decline, cosmetic blemish, foreign body sensation
- Evaluation:
fluorescein staining can diagnose epithelial herpes keratitis by presence of dendritic lesions
- Treatment:
”* opthalmology consultation
* topical antivirals treat herpetic keratitis
*topical bactericidal antibiotics treat bacterial keratitis
*antifungal eyedrops for fungal infections”
- Patient Education:
using eyeshields when working in agricultural fields
Corneal ulcer
- What is it:
corneal epithelium defect, potentially vision-threatening, starts as keratitis
- Etiology/Pathogens:
“bacterial: s. aureus
coagulase-negative staphylococcus, p. aeruginosa (contact lens wearers)
viral: HSV-1, VZV, cytomegalovirus
other causes: fungal, protozoan, pythium, autoimmune
“
- Epidemiology:
“keratitis is the precursor
contact lense wearers
unilateral usually”
- Pathophysiology:
“anatomical, mechanical, and antimicrobial defenses
microbes adhere to the surface of the cornea and replicate releasing toxin and lytic enzymes”
- Signs:
visualization of ulcer, photophobia, conjunctival injection, variable degree of vision loss
- History/Symptoms:
contact lens use, ocular surgery, ocular trauma, herpes exposure, work exposure, use of immunosuppressors, pain, redness, foreign body sensation, photophobia, tearing, watery discharge, swelling, blurred vision, gritty feeling
- Evaluation:
slit-lamp examination can help distinguish type
- Treatment:
”* culture collected by an opthalmologist
* can do a bacterial culture, fungal, viral or protozoan
*opthalmologic emergency”
- Patient Education:
advise patients on healthy contact lens use
Pterygium
- What is it:
ocular surface disorder, fibrovascular overgrowth of the subconjunctival tissue that encroaches on the cornea
- Etiology/Pathogens:
UV exposure, hot and dry weather, wind, dust, genetic predisposition
- Epidemiology:
those working outside, men more than women, particular geographic region (37 degrees north and south of equator)
- Pathophysiology:
UV rays cause insufficiency of the limbal stem cells of the cornea and activation of tissue growth factors, can grow (active) or remain static (inactive)
- Signs:
triangular tissue bilaterally formation on the lateral or medial aspect, erythema or irritation, vision disruption
- History/Symptoms:
eye irritation, lacrimation, foreign body sensation, difficulty in fitting contact lens, diminuition of vision
- Evaluation:
“ocular examination
Schirmer’s test for dry eye
refraction to characterize astigmatism”
- Treatment:
“*artificial tears
*monitoring growth
*surgical excision if growth interrupts vision
*topical vasoconstrictor”
- Patient Education:
explain chances of recurrence and proper eye protection when in sunlight
Uveitis
- What is it:
inflammation of the uvea (iris, ciliary body, choroid), categorized based on location of the inflammation
- Etiology/Pathogens:
idiopathic but can be associated with trauma, inflammation, or infection, concurrent symptoms should be analyzed
- Epidemiology:
can affect people of all ages, anterior uveitis is the most prevalent
- Pathophysiology:
not well understood, hypothesis that trauma to the eye can cause cell injury or death resulting in inflammatory cytokines
- Signs:
hypophon, cell and flare, ciliary flush
- History/Symptoms:
varies by location: pain, blurred vision, floaters, vision loss, synechia
- Evaluation:
first occurrence my not require laboratory workup, testing for HLA-B27
- Treatment:
”* eliminating inflammation and pain with steroids and topical cycloplegics
*other meds may be used to treat underlying cause”
- Patient Education:
explain disease process, complicance with treatment, and follow up, complications, and precautions on worsening symptoms
Iritis
- What is it:
inflammation of the iris, can also coincide with inflammation of the ciliary cody (anterior cyclitis) resulting in iridocyclitis, also known as anterior uveitis
- Etiology/Pathogens:
“often idiopathic, but may be a result of blunt trauma
nontraumatic iritis is often associated with HLA-B27 systemic diseases such as JRA, UC, etc. or infectious diseases like TB, chlamydia, Lyme’s”
- Epidemiology:
young and middle-aged people, responsible for 10% of legal blindness
- Pathophysiology:
non-purulent (non-supperative) or purulent (supperative), irritation of ciliary nerves and muscles causes pain
- Signs:
slit lamp evaluation gives purple hue, pupillary miosis, cells and flare present on slit beam, iris nodules
- History/Symptoms:
eye pain, photophobia, redness, tearing, decreased vision
- Evaluation:
visual acuity, intraocular pressure, slit beam
- Treatment:
“*topical cycloplegics and topical steroids
*reference to an opthalmologist”
- Patient Education:
explain ocular pathology, complications
Dacryoadenitis
- What is it:
inflammation of the lacrimal gland, inflammation can be due to infectious, or inflammatory sources but can be idiopathic
- Etiology/Pathogens:
“can be acute or chronic, acute are infectious and typically unilateral, infection often ascends from the conjunctiva, more often viral, pathogen causes are:
Epstein Barr virus, s. aureus, chronic cases are inflammatory”
- Epidemiology:
less common than dacryocystitis, acute is most common in children and young adults,
- Pathophysiology:
gland can become blocked and buildup causes inflammation and swelling
- Signs:
erythema and tenderness over the supertemporal orbit with enlargement of the gland, S curve of the eyelid margin, discharge from lacrimal ducts, swollen preauricular and cervical lymph nodes
- History/Symptoms:
pain, redness, swelling, tearing, drainage
- Evaluation:
clinical observation, chronic cases may necessitate CT or MRI of the orbits, can also do bloodwork to determine etiology or culture
- Treatment:
“*rest and warm compresses for viral causes
*if purulent can use cultures of discharge to determine antibiotic treatment (beware of MRSA)
*corticosteroids will induce shrinkage”
- Patient Education:
can do massage to induce, monitor for any concerning eye changes, educate on systemic manifestations
Dacryocystitis
- What is it:
infectious obstruction of the nasolacrimal duct, stagnation of tears in the lacrimal sac which inflames
- Etiology/Pathogens:
can be classified as acute or chronic, and acquired or congenital (dacryostenosis), most common organisms are staphylococcus species and streptococcus species
- Epidemiology:
congenital is just after birth, other cases in adults older than 40, mostly women, more often in white race
- Pathophysiology:
obstruction at any level of the nasolacrimal system, stagnation of tears, favorable environment for infectious organisms to propagate
- Signs:
edema and erythema above the nasolacrimal duct, tearing, mucopurulent discharge
- History/Symptoms:
tearing, matting, conjunctival injection, decrease in visual acuity, no pain with extraocular movements
- Evaluation:
clinical observation diagnosis, cultures and gram staining can be done using purulent material expressed via the Crigler massage, more serious cases could do blood cultures
- Treatment:
“*acute is treated with systemic antibiotics targeting staphylococcal agents (amoxicillin)
*chronic is treated with surgical therapy”
- Patient Education:
watch for changes in symptoms, or swelling spreading to medial canthal region
Dacryostenosis
- What is it:
congenital or acquired narrowing of the nasolacrimal duct and subsequent failure of tear draining into the nasal passages
- Etiology/Pathogens:
anatomical abnormalities or acquired etiologies such as infections, inflammations, medications or damage to the lacrimal system
- Epidemiology:
congenital occurs in 6% of all newborns, Down syndrome and premature birth increase likelihood as well as C section delivery
- Pathophysiology:
most often a mechanical obstruction in the distal portion of the nasolacrimal duct
- Signs:
increased size of the tear meniscus, debris on eyelashes, refluz of tears of mucoid discharge onto the eye, minimal erythema of the lower eyelid
- History/Symptoms:
“epiphora, mattering, stress epiphora
NO fever, irritability, conjunctivitis”
- Evaluation:
“clinical diagnosis in clinic
fluorescein dye dissapearance test, dacryocystography, dacryoscintigraphy”
- Treatment:
“*massaging the duct (Crigler lacrimal sac compression)
*if the problem persists past 6-10 months send to opthalmologist
*lacrimal duct probing or nasolacrimal intubation”
- Patient Education:
educate patients about the normal drainage process, if problem doesn’t resolve consider imaging and procedures
Keratoconjunctivitis sicca
- What is it:
chronic dryness of the cornea and conjunctiva from insufficienct tear production or tear evaporation
- Etiology/Pathogens:
commonly caused by autoimmune disease (Sjogren’s syndrome, rheumatoid arthritis), aging, medications (antihistamines, beta-blockers), and environmental factors
- Epidemiology:
women over 40, individuals with autoimmune conditions, prolonged screen exposure
- Pathophysiology:
aqueous tear deficiency, evaporative dry eye, meibomian gland dysfunction, hyperosmolarity of the tear film
- Signs:
normal visual acuity, tear production less than 5 mm in 5 minutes, reduced tear film breakup time, punctate epithelial erosions visible via fluorescein staining
- History/Symptoms:
dryness, burning, foreign body sensation, blurred vision, gritty sensation, epiphora, excessive blinking
- Evaluation:
“clinical symptoms and tear function tests
Schirmer’s test - measures volume of tear production
tear breakup test
slit lamp examination
fluorscein staining”
- Treatment:
“*artificial tears
*opthalmic lubricating ointment for nightime use”
- Patient Education:
advise the patient about environmental and behavioral modifications that can be performed to reduce DED
Hordeolum
- What is it:
painful, acute injection of the upper or lower eyelid
- Etiology/Pathogens:
acute bacterial infection of, usually, s. aureus on the eyelid margin due to abscess formation on the glands of the eyelashes, can progress to a chalazion
- Epidemiology:
common across age and demographics, chronic conditions may increase risk (dermatitis, diabetes, high serum lipids)
- Pathophysiology:
external hordeolum are infections of the Zeis and Moll glands, can also happen in meibomian glands
- Signs:
hot to the touch, diffuse tenderness, erythema,
- History/Symptoms:
burning and tender swelling of one eyelid, tearing, photophobia
- Evaluation:
no tests necessary, colonizations can be done but are not necessary
- Treatment:
“*resolution typically occurs spontaneously within a week
*can hasten healing with warm compresses or erythromycin ointment”
- Patient Education:
explain warm compresses
