eye Flashcards
woods lamp
stain eyelids with fluorescein and observe with blue light
rust ring around the cornea
metallic FB. removed with rotating burr
what bones comprise orbital floor
maxillary, palatine, and zygomatic
blow out fracture exam findings
limited movement (cant look up) d/t entrapment of infraorbital nn and musculature. double vision common, emphysema subq and exophtalmos(buldging eyes)
retinal detachment location, sx
superior temporal retinal area; flashing lights, floaters curtain, blurred/blackened vision occuring over few hrs
relative afferent pupillary defect. fundoscope shows rugous retina flapping in vitreous humor
retinal detachment
toxic SE of chloroquine and phenothiazine
macular degeneration
drusen deposits in bruch’s membrane causes what
leads to degenerative changes, loss of nutritional suppy, atrophy, and neovascularization [macular degeneration]
what is metamorphopsia
phenomenon of wavy or distorted vision and can be measured with an amsler grid [macular degeneration]
what can be seen on the retina with macular degeneration
mottling, serous leaks, and hemorrhages
sudden painless marked unilateral loss of vision
central retinal artery/vein occlusion
fundoscopy reveals box-carring(separation of arterial flow) and a cherry red spot
central retinal artery occlusion
optic disc swelling, afferent pupillary defect and “blood and thunder” retina
central retinal vein occlusion
tx for central retinal vein occlusion
resolves with time
what systemic disorders affect the retina
DM, HTN, preeclampsia/eclampsia, blood dyscrasias, HIV
gradual diminution of vision, double vision, fixed spots or reduced color perception
cataract sx
cataract PE
fundoscopy shows cataract black on red background. yellow tranluscent discoloration of lens
cataract tx and prognosis
intracapsular and extracapsular extraction of the cataract with lens replacement. good prognosis
what is open angle glaucoma
increased intraocular pressure due to dysfunctioning trabecular meshwork and c anal of schlemm
what is angle closure glaucoma
increased intraocular pressure due to iris obstruction
open angle glaucoma affects who
people>40 years old, more common in blacks with family history of DM or glaucoma
clinical features on angle closure glaucoma
painful eye with loss of vision; halos around lights
PE shows circumlimbal injection, steamy cornea, fixed mid dilated pupil and decreased visual acuity. N/V
Tonometry: IOP > 21
Bowing of the iris
Visual field test will show decreased peripheral vision
Visual acuity should always be tested
Fundoscopic exam
look for vessels bending over the edge of the disc
cup:disc ratio of >0.5
clinical features on open angle glaucoma
chronic asymptomatic
Tonometry: IOP > 21 (increased)
Bowing of the iris
Visual field test will show decreased peripheral vision
Visual acuity should always be tested
Fundoscopic exam
look for vessels bending over the edge of the disc
cup:disc ratio of >0.5 (increased)
tx for angle closure glaucoma
Emergency! start IV carbonic anhydrase inhibitor, topical beta blocker and osmotic diuresis. NO mydriatics. tx is laser or surgery iridotomy
tx for open angle glaucoma
refer out. need meds to decrease aqueous production and increasing outflow
orbital cellulits common in who
children. ages 7-12 years
organisms in orbital cellulitis
kids: str pneumo, st aureus, h flu, and gm neg bacteria, MRSA;
adults: secondary to chr sinusitis
primarily associated with sinusitis
eye has ptosis, purulent discharge, eyelid edema, exophthalmos and conjunctivitis
orbital cellulitis
orbital cellulitis PE
fever, decreased ROM, sluggish pupillary response
CT shows broad infiltration of orbital soft tissue
orbital cellulitis
what is dacrocystenosis and tx
lacrimal duct does not open after the first month of life. resolves by 9 months. tx warm compresses. surgical probe if needed.
what is dacrocystitis, sx, and tx
inflammation of the lacrimal gland caused by obstruction. sx: pain, swelling, redness, purulent discharge. tx is warm compresses and antibx
blepharitis causes, sx, tx
caused by seborrhea, staph, strept inf or dysfunction of meibomian glands. sx dandruff and fibrous scales. conjunctival clear. tx is shampoo.
hordeolum definition and sx
small painful nodule within a gland in eyelid. sx acute onset of pain and edema.
what is an internal hordeolum
infection of meimobian gland. situated deep with palpebral margin
what is an external hordeolum
(sty). inflammation or infection of glands of moll or zeis. situated immediately adjacent to the edge of the palpebral margin.
hordeolum organism. is it contagious? tx
st aureus. no. warm compresses. topical antibx if needed
what is a chalazion and tx
painless indurated lesion deep from palpebral margin.
often secondary to chronic inflammation of internal hordeolum
tx is warm compresses
entropion vs ectropion
entropion is eyelid and lashes turning inward d/t scar tissue or spasm or orbicularis oculi muscle. ectropion is eyelid everts d/t age, trauma, inf, palsy.
viral conjunctivitis causes, transmission, sx, tx
uni or bilateral
caused by adenovirus type 3,8,9. highly contagious.
bilateral
sx is acute onset of eryathema(uni or bil), copius watery discharge, ipsilateral tender preauricular lymphadenopathy.
tx is eye lavage with NS 7-14 days, vasoconstrictor antihistamine drops. warm to cool compresses. opthalmic sulfonamide drops to prevent secondary infection
bacterial conjunctivitis common and rare pathogens
st aure, strep pneuo, moxaxella, h aegyptius. rare are chlamydia and gonorrhoeae (these 2 can cause permanent visual impairment)
bacterial conjunctivitis sx, labs, and tx
acute onset of copius, purulent discharge from both eyes, matting. do gm stain(PMNs). tx is antibx(topical or systemic); drops more effective
sulfamonides, FQ, aminoglycosides
gm stain and giemsa stain shows intracellular gm neg diplococci
gonorrhea
fundescope shows swollen disc, margins blurred, obliteration of vessels
papilledema (think malignant HTN, hemorrhagic strokes, acute subdural hematoma, pseudotumor cerebri.
optic chaisma lesions
anterior: affect one eye.
at chiasma: affect both eyes partially.
posterior: yield defects in both visual fields
transient vision loss can be secondary to what?
TIA, amaurosis fugax(emboli), or temporal arteritis
sudden vision loss can be secondary to what?
central retinal vein occlusion, optic neuropathy, papillitis, retrobulbar neuritis
fever, malaise, increased ESR.. tender temporal artery… tx
systemic corticosteroids to prevent permanent blindness
gradual vision loss can be secondary to what?
macular degeneration, tumors, cataracts, glaucoma
test for strabismus and tx
corneal light reflex test will reveal misalignment. cover-uncover test may reveal latent strabismus. tx is patch therapy, eye exercises, or surgery
estropia vs exotropia
inward malalignment is estropia.
why should stabismus be treated after age 2
amblyopia will result
what is amblyopia
reduced visual acuity not correctable. caused by strabismus, uremia, toxins
blue or cyanotic sclera
nml or seen in infants with osteogenesis imperfecta
eye patching
for large corneal abrasions, limit to 24 hrs
slit lamp
for corneal abrasion
photophobia, tearing, injection, blepharospasm
disorder and dx tests
corneal abrasion
do acuity and slit lamp test
corneal abrasion tx
topical anesthetic, saline irrigation, antibiotic ointment(gentamycin or sulfaacetamide)
patching for large abrasions (>5-10mm)
pain, photophobia, tearing
circumcorneal injection with watery to purulent discharge
do fluorescein stain- corneal ulcer
dendritic lesion on fluorescene stain
herpes kerititis
avoid what in corneal ulcer tx
topical steroids because it can cause further tissue loss and increase risk of perforation
tear at the superior temporal retinal area usually
retinal detachment
% of bilateral retinal detachment
20
Intraocular pressure in retinal detachment
normal to reduced
relative afferent pupillary defect
retinal detachment
position for the retinal detachment pt
they should remain supine, with head turned to the side of the retinal detachment
prognosis of retinal detachment
80% will recover without recurrence
15% will require tx
5% will never reattach
leading cause of irreversible central visual loss
macular degeneration
vitamins, antioxidants, zinc & copper, omega 3 fatty acids
reduce progression of macular degeneration
mottling, serous leaks, and hemorrhages
what can be seen on the retina with macular degeneration
prognosis with central retinal artery occlusion
poor
sudden, painless, unilateral loss of vision
central retinal artery occlusion
central retinal artery occlusion position for tx
recumbent
DM, hyperlipidemia, glaucoma, hyperviscosity
risk factors for central retinal vein occlusion
intravitreal injection of vascular endothelial growth factor
for neovascularization with central retinal vein occlusion
Arteriovenous nicking, copper or silver wiring, diffuse arteriolar narrowing
hypertensive retinopathy
leading cause of blindess in US
diabetic retinopathy
nonproliferative vs proliferative diabetic retinopathy
venous dilation, microaneurysms, retinal hemorrhages, retinal edema, hard exudates
neovascularization, vitreous hemorrhage
nonproliferative vs proliferative diabetic retinopathy
venous dilation, microaneurysms, retinal hemorrhages, retinal edema, hard exudates- NON
neovascularization, vitreous hemorrhage- PROLIF
excess sun exposure
predisposes to cataract development
cataracts develop secondary to what
aging(senile cataract)
trauma
congenital diseases
systemic diseases
meds(corticosteroids, statins)
what is ocular HTN
elevated IOP without optic disc damage
chronic asymptomatic. loss of peripheral visual field(with defects), increased IOP, and has increased cup to disc ratios
clinical features on open angle glaucoma
meds to decrease aqueous production
beta blockers, carbonic anhydrase inhibitors
meds to increase outflow for open angle glaucoma
prostaglandin like meds, cholinergic agents, epinephrine components
what med decreases IOP (aqueous production) and increases outflow for open angle glaucoma
alpha agonists
what headache is triggered by darkness
closed angle glaucoma HA due to pupillary dilation
which glaucoma is more common
open angle glaucoma
frequent lens changes
think open angle glaucoma
impaired adaptation to darkness
open angle glaucoma
prolonged pupillary dilation
(prolonged period in dark room, stress, meds)
closed angle glaucoma
hard red eye
closed angle glaucoma
orbital cellulitis tx
naficillin and [flagyl or clindamycin], 2nd or 3rd gen ceph, FQ, or vanco(if MRSA)
staph aureus, b hemolytic strep, staph epidermidis, candida
dacryocystitis
sx is acute onset of eryathema(uni or bil), copius watery discharge, ipsilateral tender preauricular lymphadenopathy.
viral conjunctivitis
neisseria vs chlamydia conjunctivitis
sx
dx
neisseria: copius purulent discharge; unilateral; intraocular diplococci
chlamydia: mucopurulent discharge with marked follicular response on inner lids/ nontender periauricular adenopathy; no growth on gm stain
copius purulent discharge; unilateral; intraocular diplococci
mucopurulent discharge with marked follicular response on inner lids/ nontender periauricular adenopathy; no growth on gm stain
neisseria
chlamydia conjunctivitis
elevated yellowish fleshy conjunctival mass on sclera adjacent to cornea, nasal side
from chronic actinic exposure, repeated trauma, dry/windy conditions
pinguecula
highly vascular triangular mass grows from nasal side toward to cornea
encroaches on cornea and interferes with vision
pterygium
swollen disc, blurred margins, obliteration of vessels
papilldema
transient visual alterations that lasts for seconds
papilledema
2 tests for strabimus
corneal light reflex and cover/uncover test
2 antibiotic ointments
bacitracin or emycin every 3 hours
xray shows teardrop sign
orbital blowout fracture
dx test for
neisseria
chlamydia
chocolate agar for neisseria
giemsa stain for chlamydia
corneal ulcer organisms
pain?
staph, strep, e coli, pseudomonas
painful
chocolate agar
giemsa stain
chocoate agar: neisseria
giemsa stain: chlamydia
Aging – proteins denature over time
Trauma
Sunlight and Radiation
Genetic predisposition
Smoking is linked to an increased rate of ___ formation
Steroids
Secondary to systemic disease such as DM
think cataracts
I came in to see my physician assistant because of…
Slow progressive cloudy vision
Difficulty seeing at night
Labs, Studies and Physical Exam Findings
An eye exam will often be enough to diagnose a ___
Slit lamp may be helpful
cataracts
Risk Factors
Advancing age
African American
Family history of glaucoma
Diabetes
HTN
Hypothyroidism
Long term use of corticosteroids
glaucoma
Fundal exam
venous engorgement
hemorrhages near the optic disc
blurring of optic disc margins
Enlarged blind spot
MRI/CT to look for a cause of elevated intracranial pressure
papilledema
Causes
Most frequently traumatic. In a kid this is child abuse until proven otherwise
Blood vessel abnormality
Cancer in the eye
Sickle cell Anemia
think hyphema
hyphema tx
measure IOP
Blood is reabsorbed in a few days
Sleep with head of bed at a 45 degree angle
Recommend patient not read or watch television
Eye patch
macular degeneration tx
Laser photocoagulation
Dietary supplements including vitamin A,C, E B6, B12, zinc copper, lutein omega 3 fatty acids
Wet ARMDVascular endothelial growth factor inhibitors must be an intravitreal injection (yikes!)
ranibizumab, pegaptanib, evacizumab
1) “Curtain coming down”
2) cotton wool spots
3) Cherry red spot Central
4) boxcarring of arterioles
5) Blood and thunder fundus
6) Curtain descends and then goes back up
Retinal detachment- “Curtain coming down”
DM retinopathy- cotton wool spots
Retinal artery occlusion- Cherry red spot Central and boxcarring of arterioles
Blood and thunder fundus- Central retinal vein occlusion
Amaurosis fugax- Curtain descends and then goes back up
Think TIA of the eyeball
Causes/Predisposing factors: Carotid plaques and Atrial fibrillation
I came in to see my physician assistant today because of…
Transient ACUTE vision loss
Curtain descends and then goes back up
Unilateral
what is dx and tx?
Amaurosis Fugax
Treatment
Treat underlying cause
Heparin
I came in to see my physician assistant today because of…
Dizziness/Vertigo, N/V, Involuntary eye movement
up and down, side to side, rotary
Clinical diagnosis
Eye exam
MRI/CT checking for a mass effect
What is dx and tx?
Nystagmus
This is an involuntary movement of the eye.
Treatment
Observation
Glasses/contacts
Surgery
Hypotropia
Hypertropia
Exotropia
Esotropia
Hypotropia – one eye goes down
Hypertropia – one eye goes up
Exotropia – one eye out
Esotropia – one eye goes in
Hirschberg corneal reflex test
strasbismus
Hirschberg corneal reflex test – Shine a flashlight in patients eye. The light reflection should be in the same place on each eye.
Treatment strasbismus
Treatment
Children – the goal is to avoid amblyopia (see below)
Glasses, Eye patch, Surgery
Adults
Glasses and/or Surgery
Causes include
Congenital
Aging – loosening of the muscles and skin
Scarring
entropion
The eyelid folding inward
Causes include
Aging – loosening of the muscles and skin
Scarring
Facial nerve palsy
Ectropion
The eyelid folding outward
Ecchymosis
Difficulty with vertical eye movement
Diplopia
Infraorbital anesthesia secondary to trauma to the infraorbital nerve
Swelling
Subconjunctival hemorrhage
blow out fx
Aqueous flare – protein in the aqueous humor
Small Pupil
dx and what next
corneal ulcer
slit lamp
danger of macular degeneration
severe central vision loss. look for drusen deposits
sudden painful vision loss in a pt >60 y/o
do western sed rate, CRP to r/o temporal arteritis
