Eye Flashcards
1
Q
TRUE or FALSE: muscles pull and push
A
FASLE: muscles never push – they only pull
2
Q
This condition condition is characterized by Inflammation of the lids (can be acute and chronic), and presents with erythematous, edematous, greasy, & crusty lids?
A
Blepharitis
3
Q
Tx for Blepharitis involves?
A
Warm compresses, improved eyelid hygiene, topical abx (bacitracin, polymixin B ointments, Doxycycline).
4
Q
most common form of Blepharitis in association with?
A
Acne Rosacea or Sebhorreic dermatitis
5
Q
What bacteria most commonly colonizes Blepharitis?
A
Staphylococci.
6
Q
Sty, is also known as?
A
Hordeolum
7
Q
Sty infection involves which glands?
A
Sebaceous Gland (also known as superficial accessory glands of Zeis of Moll).
8
Q
For sty acronym SSS stands for?
A
Stye –> caused by –> Saph –> infects –> Sebaceous gland.
9
Q
Tx for Sty involves?
A
Warm compresses / topical abx drops / I&D if abx fails / Prevent cellulitis.
10
Q
Tx for chronic or severe Blepharitis?
A
Systemic antibiotics: tetracyclines or azythromycin (tx of meibomain glands - meibomitis).
11
Q
Key differences between Chalazion and Sty?
A
Chalazion: involves Meibomain Gland with symptom free or a minimally tender nodule, Firm, well demarcated, just below lid margin,
Stye: Involves Sebaceous Gland with painful nodule or pustule, Tender, erythematous, on the skin surface of the eyelid
12
Q
Tx for Chalasion?
A
Early Tx – application of warm compresses
Intermediate Tx – injection of triamcinolone (synthetic steroid – real steroid can cause skin depigmentation esp in darker skinned pts – contraindicated)
Late Tx – surgical treatment
13
Q
in non healing Chalasion, what should one suspect?
A
Basal cell, squamous cell or maibomain gland carcinoma.
14
Q
What is Chalazion?
A
Chronic inflammation of the meibomian gland (can cause depigmentation).
15
Q
Major cause of blindness from Keratitis is?
A
herpesvirus
16
Q
Primary ocular infection of Herpes Simplex is caused by?
A
HSV-1
17
Q
Herpes Simplex symptoms?
A
Mild to moderately painful symptoms of blepharitis.
18
Q
Herpes Simplex signs?
A
A vesicular eruption noted on the skin of the lids or lid margins. The rash will progress to an ulcerative lesion
19
Q
workup for Herpes Simplex?
A
Culture, if necessary.
20
Q
Tx for Herpes Simplex?
A
Good hygiene to reduce the risk of secondary bacterial infection. In moderate to severe cases topical polysporin. In moderate to severe cases Trifluridine drops to prevent secondary herpetic keratitis.
21
Q
Follow up for Herpes Simplex?
A
Referral to ophthalmologist to monitor for secondary herpetic keratitis.
22
Q
DDx for Herpes Simplex?
A
Herpes Zoster, Verruca.
23
Q
TRUE or False: Herpes Simples type 1 presents manifests as a unilateral blepharoconjuctivitis with telltale vesicles on the periocular skin of conjunctiva.
A
TRUE: in fact, unilateral blepharoconjuctivitis can be confused with adenoviral conjunctivitis if telltale vesicles on the periocular skin of conjunctiva do not appear.
24
Q
What is Nasolacrimal Duct Obstruction?
A
Blockage of nasolacrimal duct.
25
signs & symptoms of nasolacrimal duct obstruction?
Tearing (excessive)
26
etiology of Nasolacrimal Duct Obstruction?
Blocked duct from previous surgery or disease
Idiopathic
Rare - tumor
27
Work up & Tx for Nasolacrimal Duct Obstruction?
Irrigation or probing of duct (done by eye doctor).
| If above does not work – consider surgery
28
Dacryocystitis?
Infection of the lacrimal sac.
29
Dacryoadenitis?
Inflammation of the lacrimal gland.
30
symptoms of Dacryocystitis?
Tearing, pain, and mucopurulent discharge from tear duct.
31
symptoms of Dacryoadenitis:?
Lid swelling, pain, tearing.
32
signs of Dacryocystitis?
Excessive tearing, pain, mucopurulent discharge.
33
signs of Dacryoadenitis?
Lateral lid swelling, tender, erythematous, inferonasal globe displacement
34
Etiology of Dacryocystitis?
Nasolacrimal duct obstruction often the cause.
35
work up for Dacryocystitis
Digital pressure over lacrimal sac may produce mucopurulent material.
36
Tx: Dacryocystitis?
Oral broad spectrum abx – Augmentin (amoxicillin – clavulanate – I&D if abscess formed.
37
Etiology for Dacryoadenitis?
Idiopathic
Vasculitis or systemic diseases like Sjogren’s syndrome / disease (autoimmune disease that attacks exocrine glands – tears, saliva – results in dry eyes, dry mouth)
Uncommonly infection – viral or bacterial
38
work up for Dacryoadenitis?
Rule out infection – look for signs – discharge – culture PRN (A lot of skin contaminant in thee cultures)
Look for systemic disorders (i.e., Sjogren’s)
MRI or CT of the orbits
Biopsy PRN
39
Tx: Dacryoadenitis?
If idiopathic – oral corticosteroids
If there is a specific underlying inflammatory disorder treat that
If bacterial – broad spectrum abx - Augmentin
40
Follow-up: Dacryoadenitis?
Biopsy of the lacrimal gland if it fails to resolve w/appropriate therapy or is repeatedly recurrent
41
Entropion?
inversion of the lower eyelid results in Irritation / burning / FB sensation.
42
Ectropion?
sagging or eversion of the lower lid – results in Irritation / burning / tearing / FB sensation.
43
Etiology: Ectropion?
Involutional – lower lid laxity caused by aging
Paralytic – caused by a VII CN palsy
Can also be caused by scarring of lower lid or a mass on the lower lid or cheek.
44
Etiology: Entropion?
Involutional – Lower lid laxity caused by aging,
| Caused by scarring can be from chemical burn
45
Tx: Ectropion & Entropion?
Surgical correction.
46
Ptosis?
Drooping of the upper eyelid.
47
Symptoms: Ptosis?
Obstruction of superior visual field,
| Cosmetically altered appearance of the eye
48
Signs: Ptosis?
Upper lid margin is abnormally low.
49
Etiology: Ptosis?
Can be congenital,
Horner’s syndrome, or
III rd CN palsy (an be due to brain tumor)
50
Tx: Ptosis?
Treatment of underlying problem causing the condition
| Congenital – surgical correction
51
Symptoms: Xanthelasma?
Yellowish deposit around lids, Otherwise asymptomatic.
52
Signs: Xanthelasma?
Usually bilateral plaque like yellow lesion,
| Usually seen in the medial and upper eyelid
53
Etiology: Xanthelasma?
Idiopathic (elevated lipid level could increase chance).
54
Tx: Xanthelasma?
Surgical excision – for cosmetic reasons only.
55
Blepharospasm?
Eyelid twitching
| Can be caused by irritation of the conjunctiva or cornea, Stress, Caffeine or other stimulants. Rarely MS.
56
Severe spasm of the lids resulting in functional impairment is called?
Benign Essential Blepharospasm (these pt’s should be referred to ophthalmologist).
57
Eye muscles are called?
Extrinsic muscles.
58
Recti muscles move the eye which direction?
side to side and up and down.
59
What is the function of Obliques muscles of the eye?
rotate the eye?
60
CN 3 - controls which muscles of the eye?
superior/inferior/medial rectus, Inferior oblique & levator palpebrae muscle.
61
CN 4 - controls which muscle of the eye?
Superior oblique.
62
CN 6 - controls which muscle of the eye?
Lateral rectus.
63
Orbital Cellulitis?
Generalized inflammation / infection of the orbit often spreading from the paranasal sinuses.
64
Symptoms: Orbital Cellulitis?
Warm (calor), erythematous, tender swelling of the lids, can lead to diplopia or vision loss.
65
Signs: Orbital Cellulitis?
Low grade fever, Elevated WBC, Proptosis –
| Restricted motility of the eye + sluggish pupillary reflex (due to muscle pressure), decreased VA
66
Etiology: Orbital Cellulitis?
URI or sinusitis can be precursor
Most common organism in adults is strep, staph and mixed flora (sometimes)
Lid trauma
Precursor within the eye can be preseptal cellulitis – if un-Txed can lead to orbital cellulitis
Superficial lid or conjunctival infections (stye, conjunctivitis, dacryocystitis)
Surgical procedures that violate the orbit w/contamination
67
Work up: Orbital Cellulitis?
CBC, Culture if open wound is present, CT of orbits
| Possible blood culture if systemic source suspected causing sepsis.
68
Tx: Orbital Cellulitis?
Refer....
IV broad spectrum abx (if allergic to PCN – Clindamycin), Surgical drainage if abscess is present, Sinus drainage if sinuses are the source of the infection.
69
Thyroid Eye Disease can cause?
```
Exophthalmos
Proptosis
Lid retraction
Lid Lag
Ocular cranial nerve dysfunction
```
70
Symptoms: Thyroid Eye Disease?
Gradual onset of symptoms
In mild cases irritation, tearing, burning, FB sensation
In moderate cases double vision (if both eyes don’t move together in tendom), achiness, blurred vision
In severe cases visual loss and pain from corneal ulceration (as a result of corneal abrasion).
71
Proptosis / Exophthalmos?
Both mean bulging globe and are used interchangeably.
72
Common cause of Exophthalmos?
Bulging eye caused often by Graves Disease (autoimmune Dz that results in hyperthyroidism) or hyperthyroidism.
73
True of False: In proptosis, sclera is seen above or below the iris?
True: You should not see sclera above or below the iris in a normal eye – if sclera seen it is probably proptosis (eyeball pushed out forward)
74
Lid lag present with?
hyperthyroidism or Graves Dz- when pt is tracking eye movement downward the eyeball moves —> lid lags behind (normally they should move together)
75
Signs: Thyroid Eye Disease?
Proptosis, Exophthalmos, Lid lag, Restricted eye movements (EOMs ↓), Conjunctival dilated blood vessels, conjunctival edema, Decreased VA, possible VF loss.
76
Etiology: Thyroid Eye Disease?
Thyroid abnormalities – most often hyperthyroidism or Graves Dz (which causes hyperthyroidism) – but can also result from hypothyroidism
Pts may have autoimmune thyroiditis (Hashimoto’s disease - immflamatory)
Some of these ocular associated thyroid disorders may either precede or follow diagnosed thyroid Dz by years!
Many times ocular Dz develops shortly after Rx for hyperthyroidism begins.
77
Associated Factors: Thyroid Eye Disease?
Ocular pathology from thyroid Dz can stay active for 2 or more years from Dx.
78
Work up: Thyroid Eye Disease?
You can start with TSH, Full thyroid testing (TFT’s),
Continued careful monitoring of pts thyroid status,
CT or MRI if indicated (if thyroid not the cause).
79
Treatment:
Refer -->(thyroid disease treatment could also be the cause),
Mild cases may only need artificial tears (w/proptosis there is not full globe coverage by lids dry eye)
```
Moderate to severe cases Tx can include:
Elevate HOB (head of bead) at night to reduce ocular congestion, Oral prednisone to reduce edema, congestion.
```
In severe cases Orbital radiation (can result in radiation induced retinopathy though),
Orbital decompression surgery, Eye muscle surgery for entrapment due to compression
80
Follow-up:
Eye exam Q3-6 mos. & VF testing PRN
81
what effect can Diabetes, HTN, Thyroid Dz etc.. have in eye?
Ocular Manifestations of Systemic Diseases.
82
Viral Conjunctivitis?
inflammation of Conjunctiva - Pink Eye - highly contagious.
83
Symptoms: Viral Conjunctivitis?
Acute onset, with redness, watering, soreness, and general ocular discomfort.
Contralateral eye usually involved within 3 to 7 days.
84
Signs: Viral Conjunctivitis?
Diffuse injection of the conjunctiva,
Can have erythema and edema of the lids,
“Follicles” (small elevated lesions) appear on the palpebral conjunctiva,
Pre-auricular adenopathy (almost never present w/bacterial conjunctivitis).
85
Etiology: Viral Conjunctivitis?
Adenovirus.
86
Tx: Viral Conjunctivitis?
Self limiting, compresses, counsel pt re: the highly contagious nature of this disorder (don’t share any of their stuff - especially towels).
87
Symptoms: Bacterial Conjunctivitis?
Redness, irritation, and adhesion of the lids (especially in the AM).
88
Signs: Bacterial Conjunctivitis?
Mucopurulent exudate found in the fornix (corner of the eye) and lid margins
N. gonorrhoeae and N. meningitidis cause a hyperacute conjunctivitis, characterized by an exuberant discharge – this can invade the eye causing corneal perforation – ocular emergency - Refer
89
Etiology: Bacterial Conjunctivitis?
Any bacteria can cause this – staph, Haemophilus, strep.
90
Workup: Bacterial Conjunctivitis?
Gram stain and culture if Neisseria suspected.
91
Tx: Bacterial Conjunctivitis?
Broad spectrum abx – Ciloxan (fluoroquinolone)
92
Allergic Conjunctivitis?
Conjunctivitis secondary to acute allergen.
93
Symptoms: Allergic Conjunctivitis?
Prevalent symptom is intense eye itching.
94
Signs: Allergic Conjunctivitis?
Almost always bilateral (usually touching an allergen than their eyes)
Mild conjunctival injection
Stringy (hallmark for allergic conjunctivitis) mucoid discharge.
95
Etiology: Allergic Conjunctivitis?
Usually seasonal occurring in pts w/hx of atopy.
96
Tx: Allergic Conjunctivitis?
Systemic antihistamines
Removal of offending allergen if possible.
Topical vasoconstrictor / antihistamine.
97
Symptoms: Dry Eye – Keratoconjunctivitis sicca?
Foreign body sensation, dry eye, irritation, symptoms worsen as the day progresses.
98
Signs: Dry Eye?
Mild redness, usually bilateral, excessive mucus, punctate staining of the cornea with fluorescein dye (punctate (pinpoint) staining of cornea).
99
Associated Factors: Dry Eye ?
Most are idiopathic and occur in older pts,
In younger pts – contact wearers, certain collagen diseases can ↑ increase risk (RA, SLE) and sarcoidosis, drugs with anticholinergic properties (tricyclics, cogentin – Parkinson's, bronchodilators).
100
Workup: Dry Eye?
Schirmer test - tear test (pull pt’s lid down, put lid on and wait for diffusion - the higher the diffusion the better tearing is….).
101
Tx: Dry Eye?
Artificial tears, Restasis
102
Pinguecula?
Elevated fleshy conjunctival masses, most commonly found on the nasal side conjunctiva.
103
Symptoms: Pinguecula?
Usually asymptomatic
104
Signs: Pinguecula?
yellow to light brown fleshy mass found on the sclera adjacent to the cornea.
105
Etiology: Pinguecula?
Associated with chronic exposure in dry windy conditions.
106
Tx: Pinguecula?
No treatment usually necessary.
107
Difference between pterygium & pinguecula?
Will contrast Pinguecula (will never overgrow cornea - and never effect vision) with Pterygium (will overgrow cornea and effect vision)in the corneal lecture.
108
Episcleritis?
Inflammation of the fascial sheet that encases the eye.
109
Signs: Episcleritis?
acute onset of redness, dull ache if any pain at all, visual acuity is normal.
110
Symptoms: Episcleritis?
diffuse redness of one or both eyes, episcleral vessels are engorged, no discharge or corneal involvement.
111
Associated features: Episcleritis?
75% of cases idiopathic origin, can be associated with collagen vascular Dz, rosacea, gout, Zoster, most prevalent in young adults.
112
Tx: Episcleritis?
Referral to an eye doctor, but most cases are self limiting, cold compresses can help.
113
Melanoma of the Eye?
While relatively rare it is the most common primary tumor of the eye.
Often asymptomatic with perhaps a discoloration over the cornea or iris.
Needs workup to rule out metastasis.
114
Tx: Melanoma of the Eye?
Refer
| Controversial – resection vs enucleation, radiation.
115
Cherry red spot is typically is seen in pts with?
Central retinal artery occlusion
116
Cotton wool spots are seen in pts with?
Central retinal vain occlusion & diabetic retinopathy.
117
Drusen are seen in pts with?
Macular degeneration.
