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PANCE > Eye > Flashcards

Eye Flashcards

1
Q

Chronic inflammation of the eyelid

A

blepharitis

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2
Q

Causes of blepharitis? Symptoms?

A

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

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3
Q

Treatment for blepharitis?

A

warm compress, irrigation, lid massage, lid scrubs, if suspect infection - topical abs

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4
Q

painless nodular lesion on eyelid….what is it? cause? and treatment?

A

Chalazion

Cause: obstruction of tear glands (meibomian or leis)

Treatment: warm compress… if doesn’t go away can refer for excision

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5
Q

Painful, purulent nodular lesion of eyelid…what is it? cause? and treatment?

A

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

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6
Q

Define Ectropion?

A

Ectropion -
eyelid/lashes turns OUTWARD exposing the palpebral conjunctiva

secondary to age, trauma, infection, palsy of facial nerve

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7
Q

Define Entropion?

A

Entropion -
eyelid turns INWARD causing chronic conjunctival irritation

secondary to scar tissue or spasm of the orbicular coulee muscles

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8
Q

Treatment for ectropion? and entropion?

A

surgical repair

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9
Q

What is dacrostenosis?

A

duct does not open

  • common in newborns (first month of life)
  • resolves by 9 months
  • warm compress and massage
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10
Q

What is dacryoadenitis? What can this lead to?

A

inflammation of the nasolacrimal duct - due to obstruction or cyst

can lead to dacryocystitis and periorbital/orbital cellulitis

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11
Q

Treatment for dacryoadenitis?

A

cancellation of duct, dacryoplasty, stunting

if cystic = need surgery

if chronic = topical ABX

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12
Q

What is dacrycystitis? Symptoms? Treatment?

A

inflammation of the lacrimal gland caused by obstruction (staph aureus)

Symptoms: pain, swelling, tender, red, tearing, purulent discharge

Tx: warm compress and ABX

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13
Q

ptosis, eyelid edema, exophthalmos, purulent discharge

fever, decreased EOM, pain with eye movement

what should you order?

A

orbital cellulitis

CBC, blood culture, culture of any drainage

CT confirms intraorbital involvement

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14
Q

Cause of orbital cellulitis?

A

staph/strep

  • young kids (7-12 years old)
  • predisposing factors = paranasla sinusitis, eye surgery, orbital trauma, tooth infection
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15
Q

Treatment of orbital cellulitis?

A

EMERGENCY!
-IV ABX (broad spectrum)
Ex. nafcillin + metronidazole / clindamycin/ ceftriaxone / cefotaxime

Vance if MRSA

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16
Q

What are they 2 types of Glaucoma?

A
  1. open angle

2. angle-closure

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17
Q

What is glaucoma?

A

increased intraocular pressure with optic nerve damage

any impediment to the flow of aqueous flow = increases pressure in anterior chamber

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18
Q

increased intraocular pressure, asymptomatic, defect in peripheral vision

suspect findings on fundoscopy? on tonometry?

what test to confirm?

A

open angle

  • fundoscopy = increased cup to disk ratio
  • tonometry >21mmHg

confirmation: peripheral field testing

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19
Q

Treatment for open angle glaucoma?

A

need to decrease IOP

  • decrease aqueous production = BB, carbonic anhydrase inhibitors (acetazolamide)
  • increase outflow = prostaglandins (latanoprost, bimatoprost)
  • alpha agonists (brimonidine)
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20
Q

increased IOP, steamy/cloudy cornea, painful eye, fixed mid-dilated pupil, injected conjunctiva?

also n/v

A

angle closure glaucoma

=emergency

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21
Q

Treatment for angle closure glaucoma?

A

immediately refer

Start IV carbonic anhydrase inhibitor (acetazolamide, methazolamide)

topical BB

osmotic diuresis (mannitol)

optimal treatment = laser or surgical iridotomy

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22
Q

What is conjunctivitis?

A

inflammation of the conjunctiva

from = bacteria, virus, allergy, chemical, infiltration, or foreign body

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23
Q

purulent discharge from both eyes, mild discomfort, feel eyes are glued shut

cause?

A

bacterial conjunctivitis

cause = staph aureus, strep pneumo, h influ, m cat

rare = chlamydia, gonorrhea (sexual contact, vaginal delivery)

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24
Q

Diagnose bacterial conjunctivitis?

A

gram stain = polymorphonuclear (PMN) and predominant organism (NOT ROUTINELY DONE)

chlamydia = no organism seen

gonorrhea = gram - diplococci

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25
Q

Treatment for bacterial conjunctivitis?

A

hygiene = hand washing, avoid contamination

topical ABX

  • macrolide (erythromycin)
  • sulfa (sulfacetamide)
  • fluoroquinolone (cipro/ofloxacin)
  • polymixin (cortisporin/polytrim)
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26
Q

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?

A

Viral conjunctivitis

cause = adenovirus

treatment = self limiting

  • eye lavage
  • antihistamines
  • warm to cool compress
27
Q

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?

A

allergic conjunctivitis

Treatment:

  • topical (cromolyn, olopatadine)
  • oral anti-histamine (loratadine, cetirizine, fexofenadine, diphenyhydramine)
  • remove offending agent/environment
28
Q

What is corneal abrasion?

A

disruption of the corneal surface - caused by trauma, foreign body, contact lens, fingernail

29
Q

pain and sensation of foreign body, photophobia, tearing, injection, blepharospasm

slit lamp/fluorescein stain = epithelial defect, clear cornea

Treatment?

A

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
30
Q

What is corneal ulcer?

A

breakdown, necrosis or thinning of corneal surface - from inflammation or infection

31
Q

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

A

corneal ulcer

-REFER TO ophthalmologist

32
Q

fluorescein stain = dendritis lesion?

A

herpes keratitis

33
Q

what do you use to identify a foreign body in the eye? remove foreign body?

A

slit lamp

  • irrigation, swab
  • refer if need instrument usage
34
Q

What do you think of with a rust ring on the cornea?

A

metallic foreign body = need a burr to remove

35
Q

what is a pterygium? When do you treat?

A

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)

36
Q

What is pinguecula?

A

benign growth, yellowish, does NOT cross onto cornea, on nasal side

no treatment necessary

37
Q

opacity of the lens?

A

cataract

(translucent, yellow discoloration of sense)

decreases vision

38
Q

cataract risk factors?

A

age, smoking, alcohol, steroid use, sunlight exposure, DM, congenital

KIDS = TORCH (toxoplasmosis, syphilis, rubella, cytomegalovirus, herpes simplex)

39
Q

Treatment of cataract?

A

lens replacement (good prognosis)

-cataracts are leading cause of blindness!

40
Q

What are some types of retinopathy?

A

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)

41
Q

What are the 2 types of diabetic retinopathy? Treatment?

A
  1. nonproliferative = venous dilation, microaneurysm, retinal hemorrhage, retinal edema, hard exudate
  2. proliferative = NEOVASCULARIZATION, vitreous hemorrhage

Treatment = control glucose, BP, laser photocoagulation, virectomy

42
Q

patient with fib, sudden painless, marked unilateral vision loss

fundoscopy = perifoveal atrophy (cherry red spot), pallor of retina, arteriolar narrowing, box-carding

A

retinal artery occlusion

EMERGENCY

43
Q

cause of retinal artery occlusion?

A

emboli, thrombotic phenomenon, vasculitides, a fib, endocarditis, sickle cell disease, hyper coagulable state

amaurosis fugax

44
Q

sudden, unilateral, painless vision loss

exam: afferent pupillary defect, optic disc swelling, “blood and thunder retina”, superficial retinal hemorrhage/edema/exudate

A

retinal vein occlusion

central vein = most common

45
Q

risk factors of retinal vein occlusion?

A

age, HTN, DM, hyper coagulable state, glaucoma, smoking, obesity

(secondary to thrombotic event)

46
Q

Treat retinal vein occlusion?

A

ranibizumab, Intravitreal steroids, thrombolytics, surgery (vitrectomy)

47
Q

painless, blurred vision, see floaters, flashing lights, curtain being drawn over eye
… progress to blindness

Treatment?

A

retinal detachment

Tx:

  • without tear = ophthalmology f/u
  • with tear = surgery
  • patient should remain supine with head turned to side of retinal detachment
48
Q

age, central vision loss, drusen deposits (yellow retinal deposits)

A

macular degeneration

peripheral loss = glaucoma

49
Q

causes of macular degeneration?

Treatment?

A

age
drugs (chloroquine, phenothiazine)

Treatment = supportive, supplements

50
Q

difficulty driving and reading (central vision loss)

A

macular degeneration

Dry - macular atrophic changes
Wet - macular changes due to exudative or vascular changes

51
Q

patient with multiple sclerosis, has monocular vision loss, pain, sluggish pupillary response

Diagnose? Treat?

A

optic neuritis (inflammation and demyelination of optic nerve)

MRI confirm demyelination

Treatment = IV steroid

52
Q

blunt or penetrating trauma, now blood in anterior chamber, decreased visual acuity, enlarged or misshapen pupil

Treatment

A

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,

53
Q

swelling, misalignment, movement of globe is restricted, not able to look up, double vision

A

blowout fracture (direct trauma)

CT to see extent of damage

refer to ophthalmologist, avoid sneezing, coughing

54
Q

papilledema… confirm and treatment

A

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

55
Q

transient visual loss?

A

transient ischemic attack (emboli - amaurosis fugal) or giant cell arteritisi

56
Q

sudden visual loss?

A

central retinal vein or branch vein occlusion, optic neuropathy, papillitis, retrobulbar neuritis

57
Q

gradual visual loss?

A

macular degeneration, tumor, cataract, glaucoma

58
Q

icterus/jaundice?

A

yellowing of sclera

-retention of bilirubin

59
Q

blue or cyanotic sclera

A

normal or seen in infants with osteogenesis imperfect

60
Q

bitemporal heteronymous hemianopsia

A

lesion at optic chiasm (affect both eyes)

61
Q

strabismus?

A

binocular fixation is not present
-misalignment
inward = esotropia
outward = exotropia

if not treated by age 2 = amblyopia will result

62
Q

nystagmus?

A

involuntary eye movement

63
Q

optic neuritis

A

multiple sclerosis

PANCE (16 decks)

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