Eye Flashcards
Dacrocystitis
Presentation
Pain, Swelling, Redness in tear sac area
Usually unilateral
PURULENT (bacterial) discharge may be expressed
Conjunctivitis
**The MOST COMMON Eye DISEASE!!**
Inflammation of the conjunctiva
Hordeolum Tx
Warm compresses, sometimes incision or drug therapy
Bacterial Conjunctivitis
Tx
Clears in 10-14 days w/o tx, but must be isolated to prevents spreading to others
Topical Sulfa or oral ABX will clear in 2-3 days
**If lots of discharge, CULTURE to RULE OUT GYNOCOCCAL conjunctivitis
Gynococcal Conjunctivitis
- Presentation*
- Tx*
**COPIUS DISCHARGE**
EMERGENCY - may be corneal involvement
Treat Chlamydia + STD Screen
Where?
Internal Hordeolum
sty @ Meibomian gland
Lacrimal glands
Tear production, removes foreign matter and keeps eye moist
Chronic Blepharitis
Etiology
noninfectious, idiopathic inflammation
occurs often with - rosacea, recurrent hordeola/chalazia, ACNE
**SECONDARY DRY EYE**
(aka keratoconjunctivitis sicca)
Bacterial Conjunctivitis
Presentation
PURULENT/yellow discharge, - eyes stuck together
mild discomfort
Acute, ulcerative blepharitis often secondary to ….
staph or herpes viral infection
DRY EYES
Tx
Artificial tears
Lacrimal punctal occlusion (prevent drainage)
(Keratoconjunctivitis Sicca)
Where does light get converted to electrical signals
Outer portion of retina - rods (b/w) and cones (color)
Entropion
Tx
Refer
Surgery
-OR-
Botox for temp fix (especially for older person)
Presbyopia
Loss of accommodation for near vision
Blepharitis
Inflammation of the eyelid margins
Acute (ulcerative v nonulcerative)
vs
Chronic
Ectropion
Etiology
Age related
CN VII Palsy
Post Trauma Changes
“DRY EYES”
Keratoconjunctivitis sicca
Inadequate tear production or excess evaporation
Viral Conjunctivitis
Tx
COLD Compress
Sulfa drops to prevent secondary bacterial infection
Where does the outer retina get its blood supply (rods/cones)?
Choroid (not the retinal artery!)
Hordeolum Epidemiology
More common in children and teens
Chronic blepharitis
Presentation
Greasy scales at base of lashes
Pterygium
Encroachment of the conjunctiva onto the nasal side fo the cornea
Blood supply for much of the eye
Central retinal artery
Gynococcal conjunctivitis
Tx
EMERGENCY!! - corneal involvement may lead to rapid perforations
Treat possible Chlamydial Infection + do STD Screening
Uncommon in rural medicine
Chalazion presentation
hard, nontender swelling (eyelid redness, pain initially)
Hordeolum Pathophysiology
Arises from blocked sebaceous gland
Chalazion
COMMON granulomatous (full of immune cells) inflammation of meibomian gland;
may follow internal Hordeolum; noninfectious
Hordeolum Presentation
Eyelid redness, swelling, pain, tearing, photophobia, foreign body sensation
Keratoconjunctivitis sicca
Etiology
Sjogren’s syndroms, RA, SLE
Result of conditions that scar tear ducts
Affects 50% of older women
Viral Conjunctivitis
Presentation
WATERY DISCHARGE, foreign body sensation, bilateral
MOST COMMON FORM OF CONJUNCTIVITIS
Usually Adenovirus
usually d/t direct contact transmission
very contagious
Hordeolum
common “sty” - localized infection
(staph abcess) or inflammation
of the eyelid margin involving hair follicles of the eyelashes (ie, external hordeolum) or
meibomian gland (ie internal hordeolum)
HSV (Herpes Simplex Virus) Conjunctivitis
- Differential diagnosis*
- Tx*
UNILATERAL and with lid vesicles
Antivirals - topical or systemic
Acute, nonulcerative blepharitis
Presentation
Itchy RASH (normally ALLERGIC reaction)
Swollen “edematous”, red “erythmatous”
Pinguecula
Benign, yellow, elevated, nodular growth on the conjunctiva
Where?
External Hordeolum
sty @ Eyelid margin involving hair follicles of the eyelashes
Ectropion
Outward turning of the eyelid
Myopia
NEARSIGHTEDNESS - born with long eyeball; image comes into focus in front of the retina; wear concave lenses to decrease refractive power and lengthen the focal distance
Emmetropia
Normal vision
Hyperopia
FARSIGHTEDNESS - born with short eyeball; image comes into focus behind the retina; wear convex lenses to increase refractive power and shorten the focal distance
Blepharitis
Tx
Warm compresses, clean eyelids
Acute, ulcerative - abx
Acute, nonulcerative - topical corticosteroid
Chronic - ? (noninfectious)
Acute, ulcerative blepharitis
Presentation
Bacterial - CRUSTY (lashes “glued shut”), pustules may develop
Viral - Clear
Redness of lid
Astigmatism
Curvature of the cornea is uneven
Hordeolum Diagnosis
Clinical, Distinguish from chalazion
Ectropion
Tx
Eye drops
Surgery to correct
Entropion
Etiology
Age (lid fascia degenerates)
-OR-
Post Trauma/Infection scarring
Entropion
Inward turning of the eyelid,
Eyelashes rubbing cornea
General drug class to decrease inflammation/ decreasing activity of the immune system
Corticosteroids
Allergic Conjunctivitis
Presentation/Diagnosis
Itchy, watery eyes
Acute, intermittent or chronic
Seasonal/Perennial
Vernal - spring to fall more common in males
Clinical diagnosis - timing
Dacrocystitis
Infection of the Lacrimal Sac
d/t congenital or acquired obstruction
Most common cause of infectious cause of blindness worldwide
Trachoma (eye disease) due to Chlamydia keratoconjunctivitis
Chalazion tx
Warm compresses;
(alternatively incision an curettage, corticosteroids)
Corneal Ulcer
Etiology
an open sore to the cornea
associated with contact lens usea, eye trauma, eyelid abnormalities
Corneal ulcer
Tx
Refer EMERGENTLY
Corneal ulcer
most often due to …
Infection - Bacterial, viral, fungal, amoebas
Also noninfectious causes - neutrophic, exposure, dry eye, allergic eye disease, other inflammatory
Corneal ulcer
- Symptoms*
- Exam Findings*
Pain, Photophobia, Tearing, Reduced vision
Red eye with predominantly cicumcorneal injection, may be purulent or watery discharge
Infectious Keratitis
Corneal (keratin) Inflammation
caused by bacteria, virus, fungus, parasites
Infectious keratitis may precede
Corneal ulcer..
Infectious keratitis
Risk Factors
Contact lens use, corneal trauma
Infectious keratitis often shows
Hypopyon, which are..
inflammatory cells in the anterior chamber
Most common cause of infectious blindness in the western world
Herpes Simplex Keratitis
Herpes Simplex Keratitis
Symptoms
**Dendritic branching
Fungal Keratitis
Etiology
Occurrance after corneal injury involving contact with plants - gardening/agriculture
Contact lens wearers - high risk
Fungal Keratitis
- Exam*
- Tx*
Multiple stromal abcesses
Refer for Culture, treat with antifungals
Herpes Zoster Opthalmicus
Symptoms
**MALAISE, FEVER, HEADACHE
+
*Vesicular RASH becoming pustular, then crusting
(if involvement of tip of nose or lid margins
- concern for eye involvement)
Herpes Zoster Opthalmicus
Risk Factor
**HIV infection
Herpes Zoster Opthalmicus
Refer EMERGENTLY -
Trigeminal nerve involvement
Antivirals if within 72 hours of rash appearing/
corticosteroids
Acute Angle Closure Glaucoma
Presentation
Rapid onset, Extreme Pain +NAUSEA/abdominal
Blurred, profound vision loss with “HALOS AROUND LIGHTS”
Pupil dilated, not reactive to light, high IOP
*Permanent if not treated within days
Acute Angle Closure Glaucoma
Etiology
Primary - pre-existing narrow anterior chamber angle (Asian, inuit)
Secondary - hemodialysis, anterior uveitis, punched
Uveitis
General term for inlammation of the eye
Uvea - Iris, Ciliary Body, Choroid
Ocular Motor Palsies
CN 3,4,6
Symptoms
- Pain on movement
- double vision
- ptosis (eyelid droop)
- headache
- nausea
Ocular Motor Palsies
Etiology
MS, DM, Guillan Barre
3rd CN Palsy
Complete ptosis - Eye down and out
Dilated pupil, not responsive to light
If acute - Emergent, could be aneurysm
4th CN Palsy
Double vision going down stairs or reading books
Vertical hypertropia
6th CN Palsy
Failure of lateral movements,
Nystagmus
Strabismus
Misalignment of the eyes
Strabismus
Etiology
Muscle imbalance
Refractive error
Down Syndrome, congenital eye defects
Tropia
Manifest with both eyes open
Phoria
latent, seen when one eye is covered
Nystagmus
Involuntary eye movement
Treat underlying abnormalitites
congenital
acquired - associated with serious medical conditions
Acanthamoeba Keratitis
- Perineural ring and ring infiltrates into corneal stroma
- Severe pain
Cataract
1 cause of WW blindness
Opacity of the lens
Cataract
- Presentation*
- Tx*
Glare with night driving
Surgery
Cataract
Etiology
Age Related
-or-
Congenital
Retinal Detachment
Presentation
Sudden flashes, floaters, CURTAIN across vision
Retinal Detachment
Traction from PVD (Posterior Vitreous Detachment)
Possible surgical correction
Chronic angle closure glaucoma
Etiology
Common in Asian/inuit
Chronic angle closure glaucoma
Flow of aqueous fluid to anterior chamber angle obstructed
Chronic, progressive, ..
Early - asymptomatic
Vitreous hemorrhage
Blood leakage into vitreous
Retinal tear prone to bleeding - refer for laser tx to correct tear
Age-Related Macular Degeneration
Etiology
White female, age
*Leading cause of blindness in patients > 65yo in developed countries
Dry ARMD
Degeneration of the macula/retina causing..
progressive, CENTRAL vision loss
85% this milder type
Wet ARMD
NEOVASCULARIZATION - leaky “exudative”
Hemorrhage, fibrosis
See crooked lines/visual disturbances
15% ACUTELY become this more severe type
Central and Branch Retinal Vein Occlusions
PAINLESS, SUDDEN VL often upon WAKING
exam - widespread retinal hemorrhages,
Veins dilated, torturous
Optic Disc Swelling
cotton-wool spots
caused by THROMBUS (hx cardiovascular disease)
Central and Branch Arterial Occusion
SUDDEN, PROFOUND, Painless, VL
Cherry Red Fovea, RAFD
caused by THROMBUS (commonly from giant cell arteritis)
Transient Monocular Vision Loss
Ocular TIA -aka- Amaurosis Fugax
Retinal EMBOLUS from Carotid disease or the heart
(identify underlying cause to treat source)
PAINLESS, TEMP,
COMPLETE MONOCULAR - VLCurtain VERTICALLY
Crescendo TIA - multiple in a week - EMERGENCY
Diabetic Retinopathy
A leading cause of blindness
Retinal capillary closure and MICROANEURYSMS,
macular edema,
dot and blot
cotton-wool spots
Nonproliferative Diabetic Retinopathy
Mild/moderate (to severe), Very common
Often Asymptomatic
Tx- Control Blood Glucose
Proliferative Diabetic Retinopathy
Less common, more severe
NEOVASCULARIZATION
leads to Vitreous hemorrhage & traction retinal detachment
SEVERE, SUDDEN, PAINLESS VL, FLASHES & FLOATERS
Hypertensive Retinochoroidopathy
Retinal or Choroidal Damage d/t HTN
Acute - reversible
Chronic - arteriovenous nicking
Copper, Silver Wiring
Optic Neuritis
Inflammation of the Optic Nerve - associated with MS
Abrupt, monocular VL, RAPD
DIFFERENTIATE FROM OCULAR TIA:
LASTS HOURS TO DAYS + PAIN
Papilledema
Optic Disk Swelling d/t raised intracranial pressure
Optic Disk Druzen
Optic disk ELEVATION - PSEUDOPAPILLEDEMA,
associated with Farsightedness
Grave’s Opthalmyopathy
(Thyroid Eye Disease)
Inflammatory cell deposits into muscle
Diplopia, PROPTOSIS
Orbital Cellulitis
Infection of orbital tissues surrounding eye
Usually from sinuses
Serious - could spread to brain
Pain on eye movement
Perioribital cellulitis
Local infection of eyelid and surrounding skin
From bug bite/etc
Blow out Fracture
Blunt trauma Fractures Orbital Bone
Conjunctival and corneal foreign bodies
Know source - Hx
Corneal Abrasions
Hx of trauma to eye
Severe pain, tearing, foreign body sensation
Hyphema
Anterior chamber angle hemorrhage
Danger of Secondary hemorrhage, increased ocular pressure and glaucoma
Ecchymosis
“Black eye” - generally cosmetic
Ice pack 24-48 hours, then hot pack
Subconjunctival Hemorrhage
Bleeding under conjunctiva
Not painful
From straining, blood thinners
Lens Dislocation
Supporting ligaments broken - Marfan’s susceptible to this
Blurry vision, iris may quiver
Lens off center, permanent
Lacerations
Refer to Opthalmologist for repair
