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Clinical Medicine I > Eye > Flashcards

Eye Flashcards

1
Q

What is used to best exam the anterior segment of the eye?

A

Slit lamp

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2
Q

What structures are included in the anterior segment of the eye?

A 
Lids
Conjunctiva
Cornea
Iris
Lens
Anterior Chamber
Anterior Vitreous
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3
Q

What is the posterior segment of the eye best visualized by?

A

Fundoscopy

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4
Q

What structures are included in the posterior segment of the eye?

A

Retina

Optic disk

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5
Q

What is the best imaging modality to use for eye injury?

A

CT scan

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6
Q

What bones make up the eye orbit?

A 
Maxilla
Zygoma
Frontal
Palantine
Ethmoid
Sphenoid
Lacrimal
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7
Q

What are the intrinsic and extrinsic muscles of the eyeball?

A 
Superior Rectus
Lateral Rectus
Inferior Oblique
Inferior Rectus
Medial Rectus
Superior Oblique
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8
Q

What muscles do tropias effect?

A

Superior, Inferior, Medial, and Lateral Recti

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9
Q

What test is used to detect tropias?

A

Uncover, cover test

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10
Q

When does the frontal sinus usually develop?

A

age 7/8

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11
Q

What is the medial canthal ligament?

A

attaches the corner of the tarsal plate to the orbital wall

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12
Q

What is the lateral canthal ligament?

A

Attaches to lateral aspect of the orbit

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13
Q

What does disruption of the canthal ligaments cause?

A

malposition of the eyelids

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14
Q

What structures comprise the lacrimal system?

A

Lacrimal gland
Punctum
Lacrimal Sac
Nasolacrimal Duct

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15
Q

What are the orbital nerves?

A

Supra-orbital n.

Infraorbital n.

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16
Q

Is breaking of the nasal bone considered an orbital fracture?

A

NO

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17
Q

Who do orbital fractures typically occur in?

A

Young adults and adolescent males

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18
Q

What causes orbital fractures in children and adolescents?

A

Sports trauma and Projectiles

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19
Q

What causes orbital fractures in adults?

A

MVC
Assaults
Industrial accidents

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20
Q

What are the clinical manifestations of orbital fractures?

A 
Proptosis
Enophthalmus
Extrusion of intraocular contents
Subcutaneous emphysema
Widened intracanthal distance
Deformity of eye
Pain
Hematoma
Subconjunctival hemorrhage
Diplopia
Facial Numbness
N/V
Bradycardia
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21
Q

Which type of Orbital Fracture is most common?

A

Orbital Zygomatic Fracture

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22
Q

What is an orbital zygomatic fracture?

A

Caused by high impact blow to lateral orbit

Associated with fracture of orbital floor

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23
Q

What is a nasoethmoid fracture?

A

Medial orbital rim fracture

Disrupts medial canthal ligament and lacrimal duct system

Medial rectus entrapment

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24
Q

What is an orbital roof fracture?

A

High association with intracranial injury

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25
Q

Who are orbital roof fractures most common in and why?

A

children because they have a high cranium to mid-face ratio which exposes a lerger portion of upper surface

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26
Q

What are orbit injuries also considered?

A

A head injury

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27
Q

What is an orbital floor fracture?

A

BLOWOUT fracture

small round object hits the eye causing a direct blow to the infraorbital rim

Displaces globe and orbital fat

Entraps inferior rectus m.

ischemia and loss of muscle function can occur

Hematoma

Herniation of tissue into maxillary sinus

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28
Q

What is required for an orbital fracture?

A

Ophthalmic consult

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29
Q

Why should you start a patient on Augmentin or Azithromycin if they have an orbit fracture?

A

these are prophylactic antibiotics for floor fractures because of contents into maxillary sinus

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30
Q

What is the treatment for orbital fractures?

A

Stabilize the patient

Anti-nausea meds

Pain meds

Surgical repair of blowout fractures

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31
Q

What is a hyphema caused by?

A

Blunt trauma or penetrating injury to the orbit or globe

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32
Q

What is a hyphema?

A

Blood in the anterior chamber of the eye

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33
Q

What is the most common source of blood in a hyphema?

A

Tear in anterior face of the ciliary body

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34
Q

What are the clinical manifestations of hyphema?

A

Accompanied often by corneal abrasions

Worse it is, the worse prognosis for the patient to get their vision back

Vision loss

Eye pain with pupillary constriction

Photophobia

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35
Q

What imaging can be obtained to diagnose hyphema?

A

B-scan ultrasound

CT orbits with fine cuts

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36
Q

What is the goal of treatment for hyphema?

A

To prevent secondary hemorrhage and intraocular hypertension and to increase absorption of blood

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37
Q

What treatments can be used for hyphema?

A

slit lamp exam to exclude open globe injury

Topical Tetracaine eyedrops

Control N/V and pain

Prevent IOP

Head at 30 degrees to promote settling of blood

Ophthalmic consult

Patient needs to limit activity

Eye shield until resolved

Topical glucocorticoids to lower risk of bleeds –> prednisone acetate

Dexamethasone sodium phosphate QID

Cycloplegics to paralyze muscles

Mydriatics to dilate eyes

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38
Q

What are corneal abrasions caused by?

A

Eye trauma
Retained foreign body
Improper contact lens use
Defect in corneal surface epithelium

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39
Q

What are the clinical manifestations of corneal abrasions?

A 
Eye pain
Tearing
Redness
Photophobia
Blurred vision
FB sensation
Normal or decreased visual acuity
Conjunctival injection
Corneal edema
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40
Q

What is the gold standard test for corneal abrasion?

A

Fluorescein pooling under black light but only after open globe has been ruled out

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41
Q

What is used to treat a corneal abrasion?

A

Erythromycin, Polymyxin, and Sulfacetamide topicals

Contact lens wearers need to be covered for Psuedomonas:
Cirproflox or Oxiflox drops
Gentamicin or Tobramicin

Ointment is better than eyedrops

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42
Q

What indications of a corneal abrasion would require an ophthalmologic follow up?

A 
Large abrasions
Contact lens wearers
Young children
Vision changes
Rust ring
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43
Q

What layers of the cornea are involved in a corneal ulcer?

A

Epithelium and stroma

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44
Q

What causes corneal ulcers?

A 
Exposure keratitis from bell's palsy
Allergies
Severe dry eye
Autoimmune diseases
Vit A deficiency
Trauma
Bacteria
Viruses
Fungi
Amoebas
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45
Q

What bacteria can cause corneal ulcers?

A 
Pseudomonas
Staph
Strep
MRSA
MOraxella liquefaciens if diabetic or alcoholic
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46
Q

What virus causes corneal ulcers?

A

HSV/Zoster

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47
Q

What amoeba causes corneal ulcers?

A

acanthamoeba

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48
Q

What are the risk factors for corneal ulcers?

A 
Contact lens wearers
Previous eye surgery
Eye inury
History of herpes 1 or 2
Use of topical or systemic steroids
Immunocompromised
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49
Q

What are the clinical manifestations of corneal ulcers?

A 
Red eye
Discharge
Swelling of eyelids
Photophobia
Ocular pain
Foreign body sensation
Blurred vision
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50
Q

How would we diagnose a corneal ulcer?

A

Visual acuity is decreased

Eyelids and conjunctiva are erythematous

There is mucopurulent discharge

Corneal exam by slit lamp would show round or irregular ulcer with white hazy base that extends into stroma

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51
Q

If the corneal ulcer is caused by herpes zoster, what would you see on a woods lamp exam?

A

Dendrites

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52
Q

How do we treat a corneal ulcer?

A

Aggressively with topical antibiotics:
Fluoroquinolones

Antifungal if fungal: Natmycin, Amphotericin B, or Fluconazole

Topical antiviral if viral: Ganciclovir or Acyclovir

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53
Q

If you suspect a corneal ulcer, what should you do?

A

Refer patient to ophthamologist within 24-48 hours

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54
Q

What are complications of corneal ulcers?

A 
Corneal scarring
Corneal perforation
Glaucoma
Cataracts
Blindness
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55
Q

Which type of chemical injury is most severe to the eye?

A

Alkali burns

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56
Q

Why is an alkali burn to the eye so bad?

A

The alkalis liquify fatty acids of cell membranes and essentially liquify the eye

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57
Q

What are some alkali substances?

A 
Ammonia
Lye
Lime
Airbag rupture
Fireworks
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58
Q

How do we treat a chemical injury to the eye?

A

Copious irrigation with saline and morgan lens until pH in eye neutralizes

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59
Q

Who are most likely to get a corneal foreign body?

A

Men more than women

Those in 20s

Work and/or home

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60
Q

What are corneal foreign bodies caused by?

A 
Wood 
Plastic
Metal
Sand
Power tools
Windy weather
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61
Q

What are clinical manifestations of a corneal foreign body?

A 
Pain
Foreign body sensation
Photophobia
Red Eye
Blurred Vision
Normal or decreased visual acuity
Conjunctival injection
Ciliary injectino
Visible foreign body
Rust ring
Epithelial surface defects
Excessive tearing
Corneal edema
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62
Q

What tests can we use to diagnose a corneal foreign body?

A

Evert the eyelid

Fluorescein will converge wherever the FB is

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63
Q

How do we treat a corneal foreign body?

A

Remove it with cotteon q-tip, sterile needle tip, or automatic burr

use topical antibiotics such as Erythromycin or Ciprofloxacin

Irrigate eye

Cycloplegic

Patient is not allowed to wear contact lenses until it is healed

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64
Q

What is a subconjunctival hemorrhage caused b?

A

trauma
Increased venous pressure
Spontaneous rupture

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65
Q

What are the clinical manifestations of a subconjunctival hemorrhage?

A

Fragile conjunctival vessels rupture and eye will be red

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66
Q

What is the treatment for a subconjunctival hemorrhage?

A

Reassurance that it will resolve in 2-3 weeks on its own

Multiple epidsodes and bleeding disorders would warrant further workup

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67
Q

What is a retrobulbar hemorrhage?

A

Bleed behind the eye

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68
Q

How do we treat a retrobulbar Hemorrhage?

A

Cut the lateral canthal liagment to decompress the eye

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69
Q

What is an open globe laceration considered to be?

A

a tetanus prone wound

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70
Q

What are the clinical manifestations of an open globe injury?

A 
Obvious corneal or scleral laceration
Volume loss to the eye
Protruding foreign body
Extruding intraocular contents
Decreased visual acuity
RAPD
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71
Q

How do we diagnose an open globe injury?

A

CT non-contrast fine axial and coronal cuts 1-2mm

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72
Q

How do we treat an open globe injury?

A 
Surgical repair within 24 hours
Asses life-threatening injuries first
Put patient on NPO
Intubate if needed but avoid high dose ketamine and succinylcholine
Do not remove FB
Nothing in the eye
Patch on both eyes
Place head at 30 degrees
Treat N/V aggressively to avoid increase in IOP
Sedate if necessary
IV antibiotics
ophthalmic consult
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73
Q

What are some topical ophthalmic antibiotics that can be used?

A

Erythromycin 0.5% ointment QID for 5 days

Polymyxin B/Trimethoprim solution 1 drop QID for 5 days

Sulfacetamide 10% solution 1-2 drops QID for 5 days

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74
Q

What are some antipseudomonal topical antibiotics that can be used?

A

Ciprofloxacin 0.3%:
ointment –> QID for 5 days
Solution –> 1-2 drops QID for 5 days

Gentamycin 0.3%:
ointment –> BID for 3-5 days
solution –> 1-2 drops QID for 5 days

Ofloxacin 0.3% solution 1-2 drops QID for 5 days

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75
Q

What are some topical cycloplegics?

A

These paralyze the ciliary mm.

Cyclopentolate 1%, 1 drop every 5 minutes

Homatropine 5%, 1 drop every 5 minutes

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76
Q

What are some topical NSAIDS?

A

Diclofenac 0.1%, 1 drop QID for 3 days

Ketorolac 0.4%, 1 drop QID for 3 days

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77
Q

What are some topical analgesics?

A

Tetracycline 1-2 drops but cannot be prescribed, only used in ED

Proparacaine 1-2 drops

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78
Q

What is retinal detachment?

A

Separation of sensory retina from the pigment epithelium and ulderlying choroid

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79
Q

What causes retinal detachment?

A

Breaks in the retina or a leakage of vitreous humor that gets behind retina

Traction of the retina from Diabetic retinopathy

Tumors

Exudative process like infection or malignancy

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80
Q

When can permanent blindness occur in retinal detachment?

A

If the macula detaches because this is the central vision/highest acuity of vision

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81
Q

What does retinal detachment cause?

A

Ischemia and rapid progressive photoreceptor degeneration because blood source to retina is gone

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82
Q

Who often gets spontaneous retinal detachments?

A

Those patients that have a predisposition to it

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83
Q

What age group usually gets retinal detachments?

A

ages 50-75

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84
Q

What are risk factors for retinal detachments?

A

Myopia
Previous ocular surgery like cataract extraction
Fluoroquinolone use
Trauma to eye
Family history like lattice degeneration
Marfan disease

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85
Q

What is the clinical presentation of retinal detachment?

A

Increased numbe rof floaters that are persistent
Flashes of light in visual fields
Shower of black spots in the visual fields
Curtain spreading over visual field
Cloudy or smoky vision
Progression can occur form hours to days to weeks

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86
Q

What are the differential diagnoses of retinal detachment?

A

Viteous hemorrhage
Vitreous inflammation
Ocular lymphoma
Intraocular FB

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87
Q

What would you see on ophthalmoscopic exam in retinal detachment?

A

Retinal hydration lines or “billowing sail” or “ripple on a pond”

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88
Q

What is the treatment for retinal detachment?

A

CALL OPHTHAMOLOGIST IMMEDIATELY

Close tears and prevent further separation by:
Drainage of subretinal fluid
Laser photocoagulation
Cryotherapy to sclera
Pneumoretinopexy
Scleral buckle placement
Vitrectomy surgery
89
Q

What is laser photocoagulation?

A

used for holes and tears in office

Numbing drops –> retinal break localized –> 2-3 rows of 200 micron laser burns made –> 2 weeks for adhesion formation

90
Q

What is cryotherapy to the sclera?

A

in office

Lidocaine injection –> cryoretinopexy probe placed on surface of conjunctiva under break –> Freezing ball is created at tip of probe –> freezes through sclera, choroid, and retina –> multiple spots created to surround break –> 2 weeks for adhesions to form

91
Q

What is pneumoretinopexy?

A

In office for large retinal detachments

Cryoretinopexy performed then followed by injection of intravitreal gas bubble in which patient must keep head in strict position to allow bubble to push retina back in place

Adhesion will be produced

92
Q

What is a scleral buckle placement?

A

in OR

injection of lidocaine –> Cryoretinopexy performed –> Suture explant to sclera –> Explant indents wall of eye and closes retinal break –> adhesion forms

93
Q

What is optic neuritis associated with?

A

Demyelinating diseases like MS

94
Q

What is optic neuritis characterized by?

A

normal fundus exam initially

Doctor sees nothing and patient sees nothing

95
Q

Who is most likely to get optic neuritis?

A

20-40 years old

Females

White > black

96
Q

What causes optic neuritis?

A 
Demyelination/MS
Sarcoidosis
Neuromyelitis optica
Herpes Zoster
Systemic Lupus Erythematosus
97
Q

What are the clinical manifestations of optic neuritis?

A 
UNILATERAL LOSS OF VISION
PAIN EXACERBATED BY MOVEMENT
Develops over a few days
Vision ranges from 20/30 to no light perception
Field loss is central
Loss of color vision
Pain behind eye
Visual acuity will improve within 2-3 weeks to 20/40 or better
98
Q

What are the differential diagnoses for optic neuritis?

A

Infections involving optic nerve
Retinal detachment
Giant cell arteritis

99
Q

What will develop in optic neuritis?

A

Optic atrophy or optic disk pallow over several months

100
Q

What should you do if you suspect optic neuritis?

A

Get a brain MRI to assess for demyelinating plaques/MS

101
Q

How do you treat optic neuritis if placques are found?

A

Interferon beta -1a

102
Q

How should you manage optic neuritis?

A

Consult a specialist

Coritcosteroid use is controversial

103
Q

What is papilledema caused by?

A 
INCREASED INTRACRANIAL PRESSURE from:
intracranial mass lesions
Cerebral edema
Hydrocephalus thorugh increased CSF production or decreased CSF absorption
Obstruction of venous outflow
Idiopathic intracranial HTN
104
Q

What are the three stages of papilledema?

A

Early
Fully developed
Chronic

105
Q

What are the clinical manifestations of Early papilledema?

A

Loss of sponateous venous pulsations

Optic cup retained

106
Q

What are the clinical manifestations of fully developed papilledema?

A 
Optic disk elevated
Cup is obliterated
Disk margina are obscured
Blood vessels buried
Engorged veins
Flame hemorrages
Cotton wool spots that result from nerve fiber infarction
107
Q

What are the clinical manifestations of late chronic papilledema?

A

Cup remains obliterated
Hemorrhagic and exudative components resolve
Nerve appears flat with irregular margins
Disk Pallor

108
Q

What are some signs of increased ICP?

A 
Headache that is worse when lying down or upon wakening in the morning
N/V
Binocular horizontal diplopia
Pulsatile machinery-like sound in ear
Brief transient visual blurring
109
Q

How do we diagnose papilledema?

A

MRI or CT
Lumbar puncture for opening pressure
Visual field testing

110
Q

How do we treat papilledema?

A 
Decrease Intracranial pressure:
Osmotic therapy and Diuresis
Hypertonic salines
Glucocorticoids
hyperventiliation through mechnic ventilation
Barbituates
Removal of CSF by VP shunt
Decompressive craniectomy
Continuous ICP monitoring
111
Q

What are the clinical manifestations of Idiopathic intracranial hypertension?

A 
N/V
Headaches
Blurred vision
Double vision on lateral gaze
Bilateral papilledema
Spontaneous venous pulsations are absent
Visual field defects
112
Q

Who is idiopathic intracranial hypertension most common in?

A

Obese females of childbearing age

113
Q

How do we treat idiopathic intracranial hypertension?

A 
Self limited usually
Weight loss
Serial lumbar punctures
ACETAZOLAMIDE to remove water
Surgery done in severe cases --> optic sheath decrompression or lumbar peritoneal shunt
114
Q

What are differential diagnoses of idiopathic intracranial hypertension?

A

Hypertensive retinopathy

Pseudopapilledema = optic disk drusen

115
Q

What is retinal artery occlusion considered a form of?

A

STROKE

116
Q

What are the types of retinal artery occlusions?

A

central (CRAO)

Branch (BRAO)

117
Q

Which type of retinal artery occlusion is most common?

A

Central

118
Q

What types of patients get retinal artery occlusion?

A

those 60-65

Men

Have HTN, smoke, diabetes, or high cholesterol

119
Q

What is retinal artery occlusions caused by?

A

CAROTID ARTERY ATHEROSCLEROSIS –> strokes of eye
Cardiogenic emobolism in afib
Giant cell arteritis
Sickle cell disease
Hypercoagulable states
Carotid artery dissection –> UNILATERAL HEADACHE

120
Q

What are the clinical manifestations of central RAO?

A

Sudden, profound vision loss in one eye
PAINLESS
May be proceeded by transient monocular blindness, stuttering, or fluctuating course

121
Q

What are the clinical manifestations of branch RAO?

A

Monocular vision loss which may be restricted to just a part of the visual field

122
Q

How do we diagnose retinal artery occlusion?

A

Visual acuity is reduced
RAPD
Ischemic retinal whitening and “cherry red spot” in macula on fundoscopic exam

123
Q

How do we treat retinal artery occlusion?

A

Check ESR and CRP to rule out Giant cell arteritis

Consult ophthamology immediately because irreversible retinal damage can occur within hours

124
Q

What is retinal vein occlusion?

A

occluded retinal vein from thrombus formation or compression of the vein in retinal arterioles at the arteriovenous crossing point

125
Q

What are the types of retinal vein occlusion?

A

Branch (BRVO)
Central (CRVO)
Hemiretinal (HRVO)

126
Q

What is branch RVO?

A

distal vein is occluded leading to hemorrhage along distribution of a small vessel

127
Q

What is central RVO?

A

Occurs due to thrombus within central retinal vein leading to involvement of the entire retina

128
Q

What is hemiretinal RVO?

A

Occurs when blockage is in a vein that drains the superior or inferior hemiretina

129
Q

What conditions are associated with retinal vein occlusion?

A 
Diabetes
Hypertension
Leukemia
Sickle cell disease
Multiple myeloma
130
Q

What is the clinical presentation of retinal vein occlusion?

A

Sudden, painless loss of vision

131
Q

What might we see on a fundoscopic exam of someone with retinal vein occlusion?

A

Few scattered retinal hemorrhages and cotton wool spots to a marked hemorrhagic appearance

132
Q

How do we treat retinal vein occlusion?

A 
Treated right away!
Consult ophthamology:
intravitreal injections of VEGF inhibitors or triamcinolone
Retinal laser photocoagulation
Various surgical techniques
Vitrectomy with direct injection of tPA
Incision of sclera at edge of optic disk
133
Q

What is a hordeolum?

A

a stye

Acute, purulent, inflammation of eyelid

May be sterile or show bacteria

134
Q

What is the most common pathogen that causes hordeolum?

A

STAPH

135
Q

What are the types of hordeoli?

A

Internal –> infection of meibomian gland on conjunctival side
exernal –> infection of eyelash follicle on lid margin

136
Q

How do we treat hordeolum?

A

Warm compresses
+/- antibiotics
May harden and form a chalazion

137
Q

What is a chalazion?

A

chronic inflammatory lesion

138
Q

What causes a chalazion?

A

blockage and swelling of Meibomian glands of eyelid

139
Q

Who are chalazions commonly seen in?

A

patients with eyelid margin blepharitis and rosacea

patients ages 30-50

140
Q

What are the clinical manifestations of chalazions?

A

May start as small, red, tender, swollen area

Within 2-3 days it becomes painless and large, rubbery, and nodular lesion

141
Q

How do we treat chalazions?

A

Self-limiting and will resolve in weeks to months

Warm compresses

Eyelid massages

142
Q

What is an ectropion?

A

lower eyelid is rolled out

143
Q

What is ectropion caused by?

A

aging
Facial nerve paralysis
Certain dog breeds are prone to getting them

144
Q

What are the clinical manifestations of ectropions?

A 
White inner conjunctiva is exposed and visible
Excessive tearing
Chronic inflammation
Rednes
Gritty feeling
Dry eye
Crusting
MULTIPLE INFECTIONS
EYELIDS DON'T PROPERLY CLOSE
145
Q

How do we treat ectropions?

A

Temporary –> artificial tears or ointments

Permanent –> shorten and tighten lower lid

146
Q

What is an entropion?

A

eyelid rolls inward toward the eye and eyelashes rub against conjunctiva

147
Q

What is an entropion caused by?

A

Aging and weakening of certain muscles
Trauma
Scarring
Surgery

148
Q

What are the clinical manifestations of an entropion?

A 
Red eyes
Irritation
Gritty sensation
Tearing
Mucous drainage
Photophobia
Susceptible to corneal abrasions
Won't see eyelashes
149
Q

How do we treat entropions?

A

Artifical tears temporarily

Tighten eyelid and its attachments to restore eyelid position

150
Q

What is dacryoadenitis?

A

Inflammation of the lacrimal glands

151
Q

What is dacryoadenitis caused by?

A

Bacteria
Viruses
Fungi
Inflammatory diseases

152
Q

What bacteria cause dacryoadenitis?

A 
Staph aureus
strep
N. gonorrhea
Treponema
M. Tb
Chlamydia
Borrelia burgdorferi
153
Q

What viruses cause dacryoadenitis?

A 
Mumps 
EBV
Coxackie
Herpes Zoster
Mononucleosis
154
Q

What fungi cause dacryoadenitis?

A

Histoplasma
Blastomycosis
Parasites
Protozoa

155
Q

What inflammatory diseases cause dacryoadenitis?

A

Sarcoidosis

Grave’s Sjoren’s

156
Q

Who is dacryoadenitis most commonly seen in?

A

Children and neonates

157
Q

What are the clinical manifestations of acute dacryoadenitis?

A 
UNILATERAL
severe pain
Redness
swelling
Supraorbital pressure
RAPID ONSET
can look like preseptal cellulitis
Conjunctival swelling and redness
Discharge
Erythema of entire eyelid
Submandibular lymphadenopathy
Exophthalmos
Ocular motility restriction
158
Q

What are the clinical manifestations of systemic dacryoadenitis?

A

Fever
parotid gland enlargment
URI
Malaise

159
Q

What are the clinical manifestations of chronic dacryoadenitis?

A

BILATERAL
painless enlargment
Present more than 1 month
more common than acute

160
Q

How do we diagnose dacryoadenitis?

A

see enlarged gland if everting eyelid

CT scan of orbits with contrast

161
Q

How do we treat dacryoadenitis?

A

Virus is self-limiting and supportive care
Bacterial = FIRST GEN CEPH –> KELFLAX
antiaemoebic or antifungal
treat inflammatory disease accordingly

162
Q

What is Dacryostenosis?

A

Nasolacrimal duct obstruction

Most common cause of persistent tearing in infants

163
Q

How do we treat Dacryostenosis?

A

Massage
Lacrimal duct probing
Spontaneous resolution by 6-12 months

164
Q

What is blepharitis?

A

chronic eye condition characterized by inflammation of eyelids

165
Q

Which type of blepharitis is most common?

A

Posterior

166
Q

What is anterior blepharitis?

A

inflammation of the base of the eyelid or eyelahses

167
Q

What is anterior blepharitis caused by?

A

Staph

Seborrheic Dermatitis

168
Q

Who does anterior blepharitis most commonly seen in?

A

young females

169
Q

What is the pathophysiology behind anterior blepharitis?

A

Allergic response to staph antigens that colonize the eyelids

170
Q

What is the clinical presentation of anterior blepharitis?

A

Eyelid edges are pink, irritated, and swollen with crust
Malposition of eyelids in chronic cases
Eyelashes may be misdirected or thinning
Diffuse conjunctival injection

171
Q

What is posterior blepharitis associated with?

A

Rosacea and seborrheic dermatitis

172
Q

What is posterior blepharitis caused by?

A 
Inflammation of Meibomian glands which causes:
Dysfunction and altered secretions
Increase in free fatty acids
Increase in unsaturated fatty acids
Impaired lipid layer of tear film
173
Q

What are the clinical manifestations of posterior blepharitis?

A 
Red eyes
Gritty sensation
Burning
Excessive tearing
Itchy eyelids
Crusting
Flaking eyelid skin
Photophobia
Blurred vision
174
Q

How do we treat blepharitis?

A 
counsel patient 
Alleviate acute symptoms
Warm compresses
lid massage
Lid washing
artificial tears
Topical ointments for anterior --> Azithromycin or Erythromycin or Bacitracin
Oral tetracycline or docycline for 2-4 weeks for severe cases
175
Q

What is the major cause of blindness from corneal scarring worldwide?

A

Herpes Simplex keratitis

176
Q

What is Herpes simplex keratitis?

A

Corneal infection and inflammation

177
Q

How is herpes simplex keratisis transmitted?

A

Direct contact with mucous membrane

178
Q

What is the most common type of herpes simplex keratitis?

A

Infectious epithelial keratitis

179
Q

What are the types of herpes simplex keratitis?

A

Infectious epithelial keratitis
Stromal keratitis –> viral infection of stroma
Endotheliitis –> immune reaction
Neurotrophic keratopathy –> corneal hypesthesia from damage to optic nerve

180
Q

What is the incubation period of herpes simplex keratitis?

A

1-5 days

181
Q

What is the pathophysiology behind herpes simplex keratitis?

A

Active infection
Inflammation caused by infection
Immune reaction

This results in stuctural change in the cornea

182
Q

What is the clinical presentation of herpes simplex keratitis?

A

pain
Visual burning
Tearing

183
Q

How do we diagnose herpes simplex keratitis?

A

Dendritic lesions on fluorescein

184
Q

How do we treat herpes simplex keratitis/

A

Topical antivirals for mild cases:
Trifluridine
Ganciclovir
Acyclovir in europe

Oral agents in severe cases:
Valacyclovir
Famcyclovir
Gancyclovir

185
Q

What portions of the eye does preseptal/periorbital cellulitis effect?

A

Upper and lower lid and nothing else

186
Q

Who is preseptal/periorbital cellulitis most commonly seen in?

A

children

187
Q

What causes preseptal/periorbital cellulitis?

A 
Insect bites
Animal bites
FB
Dacryocystitis
Conjunctivitis
Hordeolum
S. aureus
S. pneumoniae
MRSA
188
Q

What are the clinical manifestations of preseptal/periorbital cellulitis?

A 
Ocular pain
Eyelid swelling
Erythema
Warmth
Skin infection like symptoms
189
Q

How do we diagnose preseptal/periorbital cellulitis?

A

CT or MRI will distinguish between preseptal or orbital

190
Q

How do we treat preseptal/periorbital cellulitis?

A

Bactrim (TMP-SMX) + Amox

Bactrim (TMP-SMX) + Augmentin

Bactrim (TMP-SMX) + Vantin

Bactrim (TMP-SMX) + Omnicef

Clindamycin + Amox

Clindamycin + Augmentin

Clindamycin + Vantin

Clindamycin + Omnicef

All of these are outpatient PO regimens

Doxycycline can be used in replace of Bactrim or Clindamycin except if being given to child < 8

191
Q

What is orbital cellulitis?

A

Infection involving contents of orbit such as fat and muscle but not the globe

192
Q

What is the common source of most cases of orbital cellulitis?

A

Rhinosinusitis

193
Q

Who is orbital cellulitis most common in?

A

children

194
Q

What pathogens cause orbital cellulitis?

A

S. aureus

Strep

195
Q

What are other causes of orbital cellulitis?

A

Orbital trauma
Dacryocystitis
Tooth infection
Ophthalmic surgery

196
Q

What are the clinical manifestations of orbital cellulitis?

A 
Swelling
Erythema
Warmth
Ophthalmoplegia
Proptosis
Pain with eye movement
Diplopia
197
Q

What are complications of orbital cellulitis?

A

Orbital abscess
Subperiosteal abscess
Brain abscess
Cavernous sinus thrombophlebitis

198
Q

How do we diagnose orbital cellulitis?

A

CT or MRI

199
Q

How do we treat orbital cellulitis?

A

Patients will most likely be admitted to hospital and given IV formulations of:
Vancomycin + Ceftriaxone –> for MRSA

Vancomycin + Cefotaxime or (Zosyn or Unasyn (second line)) –> for staph or strep

Improvement should be seen within 24-48 hours and if not surgery should be considered for risk of abscess

200
Q

Who are most likely to get conjunctivitis?

A

Contact wearers and its usually pseudomonas related

201
Q

What are red flags assocaited with conjunctivits?

A 
Reduction of visual acuity
Ciliary flush 
Photophobia
Fixed pupil
Corneal opacity
Severe headache with nausea
202
Q

What is bacterial conjunctivitis caused by?

A

S. aureus –> adults usually
S. pneumoniae
H. flu

203
Q

How is bacterial conjunctivitis spread?

A

highly contagious and through direct contact

204
Q

Who is bacterial conjuncitivits most common in?

A

childen

205
Q

What are the clinical manifestations of bacterial conjunctivitis?

A

UNILATERAL red eye
Discharge that may be green, yellow, or white
Often complains that eye is stuck shut
Itchy
Feels gritty like sand
Dry, crusty stuff at lid margins and corner of eye

206
Q

How do we diagnose bacterial conjunctivitis/

A

Flueorescein

Fundoscopy

207
Q

What is the first line treatment for bacterial conjunctivitis?

A

ERYTHROMYCIN ointment or trimethoprim-polymyxin drops

208
Q

What is the first line treatment for contact wearers for bacterial conjunctivitis?

A

FLUOROQUINOLONE drops

209
Q

What are other treatments for bacterial conjunctivitis?

A

Bacitracin or sulfacetamide ointment

210
Q

What causes viral conjunctivitis?

A

adenovirus

211
Q

How is viral conjunctivitis spread?

A

Direct contact and highly contagious

212
Q

What is the clinical presentation of viral conjunctivitis?

A

Viral prodrome of sore throat, fever, lymphadenopathy, and pharyngitis
Red eye
Mucoserous or watery discharge
Burning
Sandy or gritty feeling
Both eyes will be involved within 24-48 hours

213
Q

How do we diagnose viral conjunctivitis?

A

Rapid test for adenovirus

214
Q

How do we treat viral conjunctivitis?

A

Self-limited so supportive care
Warm or cool compresses
It will get worse first 3-5 days but then gradually will resolve
Topical antihistamine for itchiness –> Naphcon-A or ocuhist

215
Q

What is allergic conjunctivitis caused by?

A

Airborne allergen that comes in contact with eye

216
Q

What is the clinical presentation of allergic conjunctivitis?

A 
VERY ITCHY EYES
BILATERAL EYE REDNESS
burning
Irritation
Watery discharge
Morning crustiness
Marked chemosis
Infraorbital edema/allegic shiners
217
Q

How do we treat allergic conjunctivitis?

A

remove offending agent
Wear sunglasses
Change filters
Antihistamine/Vasoconstrictor combo –> Naphcon-A OTC
Antihistamines with mast cell stabilizers –> Olapatadine
Mast cell stabilizers –> Cromolyn sodium
Glucocorticoids –> loteprednol

218
Q

What is toxic conjunctivitis caused by?

A

Smoke
Liwuid
Fumes
Chemicals

219
Q

How do we treat toxic conjunctivitis?

A

Tetracaine drops
Immediate flushing of eye
Get pH to neutral

Clinical Medicine I (15 decks)

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