Eye Flashcards
Chronic inflammation of the eyelid
blepharitis
Causes of blepharitis? Symptoms?
Causes: seborrhea, rosacea, staph, dysfunction of meibomian gland
Symptoms: no palpable lump… signs of inflammation - red, swollen, dandruff-like depositis (scurf) and fibrous scales (collarettes), pruritus, tearing, blurred vision
Treatment for blepharitis?
warm compress, irrigation, lid massage, lid scrubs, if suspect infection - topical abs
painless nodular lesion on eyelid….what is it? cause? and treatment?
Chalazion
Cause: obstruction of tear glands (meibomian or leis)
Treatment: warm compress… if doesn’t go away can refer for excision
Painful, purulent nodular lesion of eyelid…what is it? cause? and treatment?
Hordeolum (internal and external)
Cause: staph aureus (not contagious)
Treatment: warm compress several times a day for 48 hrs. if suspect secondary infection = topical abs
Define Ectropion?
Ectropion -
eyelid/lashes turns OUTWARD exposing the palpebral conjunctiva
secondary to age, trauma, infection, palsy of facial nerve
Define Entropion?
Entropion -
eyelid turns INWARD causing chronic conjunctival irritation
secondary to scar tissue or spasm of the orbicular coulee muscles
Treatment for ectropion? and entropion?
surgical repair
What is dacrostenosis?
duct does not open
- common in newborns (first month of life)
- resolves by 9 months
- warm compress and massage
What is dacryoadenitis? What can this lead to?
inflammation of the nasolacrimal duct - due to obstruction or cyst
can lead to dacryocystitis and periorbital/orbital cellulitis
Treatment for dacryoadenitis?
cancellation of duct, dacryoplasty, stunting
if cystic = need surgery
if chronic = topical ABX
What is dacrycystitis? Symptoms? Treatment?
inflammation of the lacrimal gland caused by obstruction (staph aureus)
Symptoms: pain, swelling, tender, red, tearing, purulent discharge
Tx: warm compress and ABX
ptosis, eyelid edema, exophthalmos, purulent discharge
fever, decreased EOM, pain with eye movement
what should you order?
orbital cellulitis
CBC, blood culture, culture of any drainage
CT confirms intraorbital involvement
Cause of orbital cellulitis?
staph/strep
- young kids (7-12 years old)
- predisposing factors = paranasla sinusitis, eye surgery, orbital trauma, tooth infection
Treatment of orbital cellulitis?
EMERGENCY!
-IV ABX (broad spectrum)
Ex. nafcillin + metronidazole / clindamycin/ ceftriaxone / cefotaxime
Vance if MRSA
What are they 2 types of Glaucoma?
- open angle
2. angle-closure
What is glaucoma?
increased intraocular pressure with optic nerve damage
any impediment to the flow of aqueous flow = increases pressure in anterior chamber
increased intraocular pressure, asymptomatic, defect in peripheral vision
suspect findings on fundoscopy? on tonometry?
what test to confirm?
open angle
- fundoscopy = increased cup to disk ratio
- tonometry >21mmHg
confirmation: peripheral field testing
Treatment for open angle glaucoma?
need to decrease IOP
- decrease aqueous production = BB, carbonic anhydrase inhibitors (acetazolamide)
- increase outflow = prostaglandins (latanoprost, bimatoprost)
- alpha agonists (brimonidine)
increased IOP, steamy/cloudy cornea, painful eye, fixed mid-dilated pupil, injected conjunctiva?
also n/v
angle closure glaucoma
=emergency
Treatment for angle closure glaucoma?
immediately refer
Start IV carbonic anhydrase inhibitor (acetazolamide, methazolamide)
topical BB
osmotic diuresis (mannitol)
optimal treatment = laser or surgical iridotomy
What is conjunctivitis?
inflammation of the conjunctiva
from = bacteria, virus, allergy, chemical, infiltration, or foreign body
purulent discharge from both eyes, mild discomfort, feel eyes are glued shut
cause?
bacterial conjunctivitis
cause = staph aureus, strep pneumo, h influ, m cat
rare = chlamydia, gonorrhea (sexual contact, vaginal delivery)
Diagnose bacterial conjunctivitis?
gram stain = polymorphonuclear (PMN) and predominant organism (NOT ROUTINELY DONE)
chlamydia = no organism seen
gonorrhea = gram - diplococci
Treatment for bacterial conjunctivitis?
hygiene = hand washing, avoid contamination
topical ABX
- macrolide (erythromycin)
- sulfa (sulfacetamide)
- fluoroquinolone (cipro/ofloxacin)
- polymixin (cortisporin/polytrim)
patient has very watery discharge, was swimming with a friend who had similar symptoms, started with one eye - now both eyes, cobblestoning of palpebral conjunctiva, does not itch
what is it? cause? treatment?
Viral conjunctivitis
cause = adenovirus
treatment = self limiting
- eye lavage
- antihistamines
- warm to cool compress
patient presents in the spring after visiting a friend with a dog and now has very watery eye discharge (non purulent), cobblestoning of palpebral conjunctiva, sneezing, itchy eyes
What is it? Treatment?
allergic conjunctivitis
Treatment:
- topical (cromolyn, olopatadine)
- oral anti-histamine (loratadine, cetirizine, fexofenadine, diphenyhydramine)
- remove offending agent/environment
What is corneal abrasion?
disruption of the corneal surface - caused by trauma, foreign body, contact lens, fingernail
pain and sensation of foreign body, photophobia, tearing, injection, blepharospasm
slit lamp/fluorescein stain = epithelial defect, clear cornea
Treatment?
corneal abrasion
- topical anesthetic (only used to confirm diagnosis - can retard healing)
- saline irrigation, abx ointment (gentamicin, sulfacetamide)
- tylenol for pain
- PATCHING if large abrasion
What is corneal ulcer?
breakdown, necrosis or thinning of corneal surface - from inflammation or infection
patient presents with pain, photophobia, tearing, circumcorneal injection, discharge, uses contact lens
fluorescein stain = dense corneal infiltrate, overlying epithelial defect
seen on penlight exam too
corneal ulcer
-REFER TO ophthalmologist
fluorescein stain = dendritis lesion?
herpes keratitis
what do you use to identify a foreign body in the eye? remove foreign body?
slit lamp
- irrigation, swab
- refer if need instrument usage
What do you think of with a rust ring on the cornea?
metallic foreign body = need a burr to remove
what is a pterygium? When do you treat?
benign vascular corneal growth (slow growing thickening of the bulbar conjunctiva)
triangle mass from nasal side to cornea
Treatment = if interferes with vision (common recurrence)
What is pinguecula?
benign growth, yellowish, does NOT cross onto cornea, on nasal side
no treatment necessary
opacity of the lens?
cataract
(translucent, yellow discoloration of sense)
decreases vision
cataract risk factors?
age, smoking, alcohol, steroid use, sunlight exposure, DM, congenital
KIDS = TORCH (toxoplasmosis, syphilis, rubella, cytomegalovirus, herpes simplex)
Treatment of cataract?
lens replacement (good prognosis)
-cataracts are leading cause of blindness!
What are some types of retinopathy?
hypertensive and diabetic (#1)
-inflammatory = behcet, sarcoidosis, sle, giant cell arteritis, polyarteritis nods, wagerer’s granulomatosis
infectious = syphilis, herpes simplex, varicella zoster, TB, toxoplasmosis, CMV (HIV)
What are the 2 types of diabetic retinopathy? Treatment?
- nonproliferative = venous dilation, microaneurysm, retinal hemorrhage, retinal edema, hard exudate
- proliferative = NEOVASCULARIZATION, vitreous hemorrhage
Treatment = control glucose, BP, laser photocoagulation, virectomy
patient with fib, sudden painless, marked unilateral vision loss
fundoscopy = perifoveal atrophy (cherry red spot), pallor of retina, arteriolar narrowing, box-carding
retinal artery occlusion
EMERGENCY
cause of retinal artery occlusion?
emboli, thrombotic phenomenon, vasculitides, a fib, endocarditis, sickle cell disease, hyper coagulable state
amaurosis fugax
sudden, unilateral, painless vision loss
exam: afferent pupillary defect, optic disc swelling, “blood and thunder retina”, superficial retinal hemorrhage/edema/exudate
retinal vein occlusion
central vein = most common
risk factors of retinal vein occlusion?
age, HTN, DM, hyper coagulable state, glaucoma, smoking, obesity
(secondary to thrombotic event)
Treat retinal vein occlusion?
ranibizumab, Intravitreal steroids, thrombolytics, surgery (vitrectomy)
painless, blurred vision, see floaters, flashing lights, curtain being drawn over eye
… progress to blindness
Treatment?
retinal detachment
Tx:
- without tear = ophthalmology f/u
- with tear = surgery
- patient should remain supine with head turned to side of retinal detachment
age, central vision loss, drusen deposits (yellow retinal deposits)
macular degeneration
peripheral loss = glaucoma
causes of macular degeneration?
Treatment?
age
drugs (chloroquine, phenothiazine)
Treatment = supportive, supplements
difficulty driving and reading (central vision loss)
macular degeneration
Dry - macular atrophic changes
Wet - macular changes due to exudative or vascular changes
patient with multiple sclerosis, has monocular vision loss, pain, sluggish pupillary response
Diagnose? Treat?
optic neuritis (inflammation and demyelination of optic nerve)
MRI confirm demyelination
Treatment = IV steroid
blunt or penetrating trauma, now blood in anterior chamber, decreased visual acuity, enlarged or misshapen pupil
Treatment
hyphema
r/o blowout fracture, lens trauma, skull or cervical fracture
Treatment = eye protection, rest with head of bed at 30 degrees, topical beta adrenergic blockers,
swelling, misalignment, movement of globe is restricted, not able to look up, double vision
blowout fracture (direct trauma)
CT to see extent of damage
refer to ophthalmologist, avoid sneezing, coughing
papilledema… confirm and treatment
from increased intracranial pressure (tumor/bleed, cerebral edema, CSF outflow obstruction, overproduction), results in swelling of optic disk
confirm: imaging and lumbar puncture (increased opening pressure)
Treatment = underlying intracranial disorder
transient visual loss?
transient ischemic attack (emboli - amaurosis fugal) or giant cell arteritisi
sudden visual loss?
central retinal vein or branch vein occlusion, optic neuropathy, papillitis, retrobulbar neuritis
gradual visual loss?
macular degeneration, tumor, cataract, glaucoma
icterus/jaundice?
yellowing of sclera
-retention of bilirubin
blue or cyanotic sclera
normal or seen in infants with osteogenesis imperfect
bitemporal heteronymous hemianopsia
lesion at optic chiasm (affect both eyes)
strabismus?
binocular fixation is not present
-misalignment
inward = esotropia
outward = exotropia
if not treated by age 2 = amblyopia will result
nystagmus?
involuntary eye movement
optic neuritis
multiple sclerosis
