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Patho & Pharm > eye > Flashcards

eye Flashcards

1
Q

conjunctivitis

A

An inflammatory hyperaemia of the conjunctiva with/without discharge

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2
Q

Causes of conjunctivitis

A

Infectious
– bacterial
– viral
– chlamydial
* Non-infectious
– Allergic
– Dry eye
– Toxic or chemical reaction – Contact lens use
* Foreignbody
* Idiopathic

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3
Q

Drugs for bacterial conjunctivitis

A

Fluoroquinolones
ciprofloxacin (Ciloxan), ofloxacin (Ocuflox), moxifloxacin (Vigamox), gatifloxacin (Zymar)

Aminoglycosides
* tobramycin(Tobrex),gentamycin(Garamycin) Often combined with a steroid (e.g. Tobradex)

Polymixin B Combos
* polymixinB/trimethoprim (Polytrim), polymixinB/bacitracin (Polysporin)

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4
Q

etiology of bacterial conjuctivitis

A

Gram positive bacteria

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5
Q

etiology of viral conjunctivitis

A

History of upper respiratory tract infection or exposure
* otitis media, diarrhea, sore throat in children
* human adenovirus types 8,19, 29 & 37
* 1-3% of people with COVID-19 (based on data so far)

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6
Q

differences between bacterial and viral conjuctivitis

A

viral: tender palpable PAN
bacterial: No preauricular node (PAN)

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7
Q

Vernal keratoconjunctivitis

A

seasonally recurrent (spring/summer), 4-20 yrs old, M>F

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8
Q

Atopic keratoconjunctivitis

A

no seasonal variation, uncommon, late teens-50 yrs old * with atopic diseases, i.e. asthma, dermatitis, rhinitis

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9
Q

LID/LACRIMAL DISORDERS

A

Blepharitis
Hordeolum & Chalazion
Nasolacrimal duct obstruction – Congenital (dacryostenosis)
– Infectious (dacryocystitis)
Orbital cellulitis (emergency) vs preseptal cellulitis

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10
Q

s/s Blepharitis

A

Scales/collarettes at base of lashes * Lash misdirection (trichiasis)
* Edema of lid margins
Symptoms
* Burning, stinging itching
* Foreign body sensation

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11
Q

Dacryostenosis

A

Congenital disorder that resolves in the first year of
life in 90% of cases
Management – downward massage at duct (with warm heat if possible)

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12
Q

Dacryocystitis

A

Inflammation of the nasolacrimal sac
– Pain, erythema, edema
– Requires IV antibiotics and referral ER ophthalmologist

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13
Q

HORDEOLUM/CHALAZION

A

eye styes
hordeolum: tender
chalazion: gland, nontender

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14
Q

what’s an eye emergency ?

A

If there is proptosis, pain with eye movement and restricted motility, then think ORBITAL CELLULITIS

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15
Q

KERATITIS

A

Infectious
– active infection in cornea, treat with anti-infective
Non-infectious
– inflammatory response, treat with lubricants and steroids

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16
Q

s/s of microbial keratitis

A

Severe hyperemia
* discharge
* ulcer with surrounding edema/infiltrate – paracentral/central
– >1mm
* overlying staining – epithelial break
* anterior chamber reaction
* lidedema
* reduced vision
- Mild to severe pain
* photophobia
* epiphora

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17
Q

etiology of microbial keratitis

A

Infection of the cornea by replicating microbes
– bacterial, viral, fungal or amoebae
* Usually preceded by hypoxia and/or epithelial
break
* Characterized by ulceration of the cornea * Infiltration and necrosis of the tissue

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18
Q

treatment of microbial keratitis

A

Ocular emergency
* if wearing contacts, cease lens wear
* obtain immediate medical management
– referral to experienced corneal specialist indicated in severe cases
* NO patching (never with suspected infections) * oral painkillers
* cycloplegic agent
* fluoroquinolone drops - commence q15

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19
Q

HSV eye infection

A

light sensitivity
* foreign-body sensation
* scattered punctate epitheliopathy
* branching, dendriticlesion with club-shaped terminal end-bulbs

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20
Q

treatment of HSV eye infection

A

gentle debridement of infected epithelial area
* Trifluridine 1% drops 5-9x/day for 2/52 – Viroptic
* cycloplegic – if AC reaction present
* oral antiviral (acyclovir) may be used if topicals
prove too toxic
* avoid steroid use because of increased risk of secondary bacterial infection

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21
Q

sterile keratitis

A

Hyperemia
* Photophobia
* Mild pain only
* Peripheral location of corneal stromal infiltrates
* No anterior chamber reaction
* No mucopurulent discharge

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22
Q

etiology of sterile keratitis

A

Staphylococcal antigens
– Infiltrates result from a noninfectious reaction of host’s antibodies to the staphylococcal antigens
– Ocular rosacea patients
– Contact lens users (called contact lens peripheral ulcer)

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23
Q

treatment for sterile keratitis

A

MILD
* Warm compresses
* Eyelid hygiene
* Erythromycin or bacitracin ointment, or fluorquinolone
MODERATE to SEVERE
* Add a steroid
* Combination antibiotic/steroid (e.g. Tobradex drops or ointment qid with taper)
* For recurrent episodes, tetracycline 250 mg or docycycline 100 mg

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24
Q

ANTERIOR UVEITIS s/s

A

Acute Anterior Uveitis (Iritis)
* photophobia
* pain
* decreased vision
* tearing probably secondary to pain and photophobia
* redness

Chronic Anterior Uveitis
* may be asymptomatic
* mild discomfort with minimal redness

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25
Q

Circumcorneal (ciliary) Injection

A

Deep redness more pronounced around limbus and less towards fornices

26
Q

s/s of anterior uveitis

A

Cells in anterior chamber
– Leucocytes floating in anterior chamber – Indicate active inflammation

  • KeraticPrecipitates(KP)
    – Cellular deposits on corneal endothelium
  • Lower Intraocular Pressure (IOP)
  • Smaller pupil on affected side
  • Pain in affected eye when light shone in unaffected eye (“Henkind” test)
    – due to consensual pupil response in affected eye – useful test when signs are minimal
  • Iris heterochromia – in chronic cases
27
Q

etiology of acute uveitis

A

Idiopathic (common form of uveitis)
* HLA-B27 Associated Uveitis (young men with back pain)
– Ankylosing Spondylitis (~30% have uveitis) – Reiter Syndrome (~20% have uveitis)
* Trauma (including post-surgical)
* Behcetdisease
* Also, influenza, adenovirus, mumps, measles, Lyme disease

28
Q

etiology of chronic uveitis

A

Chronic Uveitis
* Juvenile Rheumatoid Arthritis (esp young girls) * Fuch’s Heterochromic Iridocyclitis (rare) Chronic Uveitis with granulomatous signs
* Sarcoidosis (15% have uveitis)
* Herpes simplex/zoster * Tuberculosis
* Syphilis

29
Q

treatment for acute uveitis

A

Mydriatics (e.g. cyclopentolate, homatropine, atropine)
* Given as eye drops
* Inhibits iris sphincter and ciliary muscle – dilates pupil
– inhibits accommodation
– results in increased comfort
* Prevents posterior synechiae formation
* Breaks down newly formed synechiae

30
Q

Complications of Steroids

A
  • Increased IOP and glaucoma – Steroid responders – Discontinue drug or treat IOP
  • Cataract
    – Higher risk with systemic drugs
  • Systemic
    – Adrenal suppression
  • Drugs must be tapered before discontinuation
31
Q

EPISCLERITIS

A

The episclera lies beneath the conjunctiva and over the sclera.
* Consists of dense vascular connective tissue.

32
Q

s/s of episcleritis

A

sectoral redness involving the episcleral vessels (can be moved with manipulation)
* mild tenderness on palpation, but not painful
* blanches with phenylephrine 2.5%
* recurrent
* young adults, women>men
* never progresses to scleritis or corneal involvement
* resolves in 1-2 weeks, longer if there is a localized, raised nodule

33
Q

etiology of episcleritis

A

usually idiopathic
* collagen vascular disease – Rheumatoid arthritis
– Ankylosing spondylitis
– Psoriatic arthritis
– Systemic lupus erythematosus – Scleroderma
– Dermatomyositis
– Polyarteritis nodosa
* gout

34
Q

treatment for episcleritis

A

self-limiting
* artificial tears for comfort
* If persistent and or aches: topical NSAIDs (e.g. ketorolac) and or topical corticosteroids (e.g. predinosolone or loteprednol)

35
Q

SCLERITIS

A

Edema and cellular infiltration of entire thickness of the sclera

36
Q

s/s of scleritis

A

Similar to episcleritis but discomfort more severe
* Injection of superficial scleral vessels
* Does not blanch with phenylephrine
* May have a nodule similar to nodular episcleritis, but nodule cannot be moved

37
Q

etiology of scleritis

A

Systemic associations e.g. Rheumatoid arthritis most frequent
Surgically induced / trauma
Infectious

38
Q

treatment of scleritis

A

Oral NSAIDs
* Oral steroids
– eg Prednisolone
* Combined therapy
– both NSAID and steroid
* Sub-conjunctival steroid injection

39
Q

DRY EYE SYNDROME s/s

A

Injection is global and bilateral
* Punctate lesions and erosions visible with a slit lamp
* Burning or foreign body sensation
* May have decreased vision
* May have excess tearing
* Mucus or debris in tear film and filaments on the cornea

40
Q

What’s DRY EYE SYNDROME

A

Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface

41
Q

pathophysiology of dry eye

A

Aqueous deficient dry eye (ADDE) and evaporative dry eye (EDE) exist as a continuum
* In ADDE, tear hyperosmolarity results when lacrimal secretion is reduced, in conditions of normal evaporation from the eye. Most common cause is inflammation of the lacrimal gland encounted with Sjogren syndrome.
* In EDE, tear hyperosmolarity is caused by excessive evaporation from the exposed tear film in the presence of a normally functioning lacrimal gland. Caused by meibomian gland dysfunction (MGD).

42
Q

etiology of dry eye syndrome

A

3 major systemic associations: diabetics, thyroid, arthritis
* Aging
* Environmental factors : smoke, wind, heat, low humidity
* Ocular allergy
* Low blink rate, especially working on computer
* Wide lid aperture
* Systemic drugs: antihistamines, beta-blockers, antispasmodics, diuretics, some psychotropic drugs
* Topical preservatives
* Contact lens wear
* Refractive surgery (including LASIK)
* Certain skin disorders, such as acne rosacea, atopic dermatitis

43
Q

treatment of dry eye syndrome

A

Artificial tears (drops or ointment)
* Environmental modifications (e.g. humidifier, avoidance)
* Omega 3 fatty acid supplements
* Flax see oil
* Cyclosporine gtts (Restasis)

44
Q

s/s of CORNEAL/CONJUNCTIVAL TRAUMA

A

Conjunctival injection
* Epithelial defect that stains with fluorescein * Sharp pain
* Photophobia
* Foreign body sensation
* Tearing

45
Q

treatment for corneal trauma

A

Antibiotic
– Non-contact lens wearer: Antibiotic ointment (e.g. erythromycin, bacitracin or ciprofloxacin, q2-4h) or drops (e.g. fluoroquinolone, polymyxin B/trimethoprim)
– Contact lens wearer: Must have antipseudomonal coverage. Antibiotic ointment (e.g. tobramycin or ciprofloxacin, q2-4h) or drops (e.g. moxifloxacin, gatifloxacin, qid)

Cycloplegic agent for traumatic iritis (may develop 24-72 hours after trauma)
* Consider patch for comfort, except when injury involves vegetable matter, false fingernails or contact lenses
* Consider NSAID drops (e.g. ketorolac qid for 3 days)
* If present, remove foreign body under topical anesthesia (e.g proparacaine)

46
Q

etiology of SUBCONJUNCTIVAL HEMORRHAGE

A

commonly idiopathic
* transient increase in venous (intrathoracic) pressure (i.e. Valsalva manoeuvre)
– coughing, sneezing, vomiting, straining
* severe alcohol intoxication, leading to raised
blood pressure
* eye trauma
* blood dyscrasia (rare)
* severe hypertension(rare)
* Blood thinners [anticoagulant medications]

47
Q

treatment for SUBCONJUNCTIVAL HEMORRHAGE

A

none required
* clears in 10-14 days * Reassurance

48
Q

SUBCONJUNCTIVAL HEMORRHAGE

A

“Bleeding” beneath the conjunctiva
* many small fragile vessels
* lots of space between sclera
and conjunctiva
* blood spreads easily – looks worse than it is!
* Not painful - mild irritation and FB sensation

49
Q

ACUTE ANGLE CLOSURE GLAUCOMA

A

Conjunctival injection
* Fixed, mid-dilated pupil
* Increased IOP
* Corneal microcystic edema
* Pain
* Blurred vision
* Coloured haloes around lights
* Frontal headache
* Nausea and vomiting

50
Q

etiology of ACUTE ANGLE CLOSURE GLAUCOMA

A

Pupillary Block
– Narrow anterior chamber angles, anterior iris insertion of the iris root, or both. Common in Asians, Inuit [sincere apology for terminology error], and hyperopes.
– May be precipitated by topical mydriatics (pupil dilation agents), systemic anticholinergics (e.g. antihistamines, antipsychotics)
– Accommodation (e.g. reading) or dim illumination (e.g., movie theatre)
* Abnormal iris configuration (e.g. plateau iris) causing angle crowding

51
Q

treatment of ACUTE ANGLE CLOSURE GLAUCOMA

A

Ocular emergency
* if wearing contacts, cease lens wear
* obtain immediate medical management Drugs
* Topical beta blocker or alpha agonist, steroid – Pilocarpine if phakic
– Mydriatic and cycloplegic if aphakic/pseudophakic
* Oral carbonic anhydrase inhibitor (e.g. acetazolamide 2x250 mg tablets in one dose)

52
Q

Diabetic Retinopathy stages

A

Mild nonproliferative
Moderate nonproliferative
Severe nonproliferative
Proliferative diabetic retinopathy

53
Q

Diabetic Macular Edema

A

Can occur with or without other forms of retinopathy.
* VEGF causes retinal capillaries to leak
* Common cause of vision loss in diabetics
* Prompt referral for anti-VEGF treatment or retinal laser

54
Q

Treatment for diabetic macular edema

A

Best way to treat retinopathy is to prevent it
* Laser panretinal photocoagulation (PRP) for severe NPDR and PDR
* More recently, intravitreal injections to inhibit VEGF

55
Q

two forms of Age-Related Macular Degeneration

A

dry and wet

56
Q

dry Age-Related Macular Degeneration

A

Dry AMD occurs when parts of the macula get atrophy with age and tiny clumps of protein called drusen occur.

57
Q

wet Age-Related Macular Degeneration

A

Wet is more serious. VEGF causes neovascularization, which can leak blood or other fluids.

58
Q

s/s of Age-Related Macular Degeneration

A

rapid or gradual loss of central vision. In wet AMD, metamorphopsia, central or paracentral scotoma.

59
Q

diagnosis of Age-Related Macular Degeneration

A

retinal exam, Amsler grid, imaging, fluorescein angiogram

60
Q

management of Age-Related Macular Degeneration

A

Lifestyle modification: healthy diet rich in leafy greens and omega-3 rich fish, regular exercise, avoiding smoking
* Systemic disease management: cardiovascular disease, DM, hypercholesterolemia, and obesity
* UV protection

61
Q

management with Dry and Wet AMD

A

Dry AMD
– Frequent eye exams – AREDSII vitamins
* Wet AMD
– Prompt referral for anti-VEGF therapy

62
Q

Risk factors of Age-Related Macular Degeneration

A

Risk factors: family history, smoking, obesity, hypertension, hypercholesterolemia, age, hyperopia, blue eyes

Patho & Pharm (36 decks)

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