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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
Who are orbital roof fractures most common in and why?
children because they have a high cranium to mid-face ratio which exposes a lerger portion of upper surface
26
What are orbit injuries also considered?
A head injury
27
What is an orbital floor fracture?
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
28
What is required for an orbital fracture?
Ophthalmic consult
29
Why should you start a patient on Augmentin or Azithromycin if they have an orbit fracture?
these are prophylactic antibiotics for floor fractures because of contents into maxillary sinus
30
What is the treatment for orbital fractures?
Stabilize the patient Anti-nausea meds Pain meds Surgical repair of blowout fractures
31
What is a hyphema caused by?
Blunt trauma or penetrating injury to the orbit or globe
32
What is a hyphema?
Blood in the anterior chamber of the eye
33
What is the most common source of blood in a hyphema?
Tear in anterior face of the ciliary body
34
What are the clinical manifestations of hyphema?
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
35
What imaging can be obtained to diagnose hyphema?
B-scan ultrasound CT orbits with fine cuts
36
What is the goal of treatment for hyphema?
To prevent secondary hemorrhage and intraocular hypertension and to increase absorption of blood
37
What treatments can be used for hyphema?
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
38
What are corneal abrasions caused by?
Eye trauma Retained foreign body Improper contact lens use Defect in corneal surface epithelium
39
What are the clinical manifestations of corneal abrasions?
``` Eye pain Tearing Redness Photophobia Blurred vision FB sensation Normal or decreased visual acuity Conjunctival injection Corneal edema ```
40
What is the gold standard test for corneal abrasion?
Fluorescein pooling under black light but only after open globe has been ruled out
41
What is used to treat a corneal abrasion?
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
42
What indications of a corneal abrasion would require an ophthalmologic follow up?
``` Large abrasions Contact lens wearers Young children Vision changes Rust ring ```
43
What layers of the cornea are involved in a corneal ulcer?
Epithelium and stroma
44
What causes corneal ulcers?
``` Exposure keratitis from bell's palsy Allergies Severe dry eye Autoimmune diseases Vit A deficiency Trauma Bacteria Viruses Fungi Amoebas ```
45
What bacteria can cause corneal ulcers?
``` Pseudomonas Staph Strep MRSA MOraxella liquefaciens if diabetic or alcoholic ```
46
What virus causes corneal ulcers?
HSV/Zoster
47
What amoeba causes corneal ulcers?
acanthamoeba
48
What are the risk factors for corneal ulcers?
``` Contact lens wearers Previous eye surgery Eye inury History of herpes 1 or 2 Use of topical or systemic steroids Immunocompromised ```
49
What are the clinical manifestations of corneal ulcers?
``` Red eye Discharge Swelling of eyelids Photophobia Ocular pain Foreign body sensation Blurred vision ```
50
How would we diagnose a corneal ulcer?
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
51
If the corneal ulcer is caused by herpes zoster, what would you see on a woods lamp exam?
Dendrites
52
How do we treat a corneal ulcer?
Aggressively with topical antibiotics: Fluoroquinolones Antifungal if fungal: Natmycin, Amphotericin B, or Fluconazole Topical antiviral if viral: Ganciclovir or Acyclovir
53
If you suspect a corneal ulcer, what should you do?
Refer patient to ophthamologist within 24-48 hours
54
What are complications of corneal ulcers?
``` Corneal scarring Corneal perforation Glaucoma Cataracts Blindness ```
55
Which type of chemical injury is most severe to the eye?
Alkali burns
56
Why is an alkali burn to the eye so bad?
The alkalis liquify fatty acids of cell membranes and essentially liquify the eye
57
What are some alkali substances?
``` Ammonia Lye Lime Airbag rupture Fireworks ```
58
How do we treat a chemical injury to the eye?
Copious irrigation with saline and morgan lens until pH in eye neutralizes
59
Who are most likely to get a corneal foreign body?
Men more than women Those in 20s Work and/or home
60
What are corneal foreign bodies caused by?
``` Wood Plastic Metal Sand Power tools Windy weather ```
61
What are clinical manifestations of a corneal foreign body?
``` 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 ```
62
What tests can we use to diagnose a corneal foreign body?
Evert the eyelid Fluorescein will converge wherever the FB is
63
How do we treat a corneal foreign body?
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
64
What is a subconjunctival hemorrhage caused b?
trauma Increased venous pressure Spontaneous rupture
65
What are the clinical manifestations of a subconjunctival hemorrhage?
Fragile conjunctival vessels rupture and eye will be red
66
What is the treatment for a subconjunctival hemorrhage?
Reassurance that it will resolve in 2-3 weeks on its own Multiple epidsodes and bleeding disorders would warrant further workup
67
What is a retrobulbar hemorrhage?
Bleed behind the eye
68
How do we treat a retrobulbar Hemorrhage?
Cut the lateral canthal liagment to decompress the eye
69
What is an open globe laceration considered to be?
a tetanus prone wound
70
What are the clinical manifestations of an open globe injury?
``` Obvious corneal or scleral laceration Volume loss to the eye Protruding foreign body Extruding intraocular contents Decreased visual acuity RAPD ```
71
How do we diagnose an open globe injury?
CT non-contrast fine axial and coronal cuts 1-2mm
72
How do we treat an open globe injury?
``` 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 ```
73
What are some topical ophthalmic antibiotics that can be used?
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
74
What are some antipseudomonal topical antibiotics that can be used?
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
75
What are some topical cycloplegics?
These paralyze the ciliary mm. Cyclopentolate 1%, 1 drop every 5 minutes Homatropine 5%, 1 drop every 5 minutes
76
What are some topical NSAIDS?
Diclofenac 0.1%, 1 drop QID for 3 days Ketorolac 0.4%, 1 drop QID for 3 days
77
What are some topical analgesics?
Tetracycline 1-2 drops but cannot be prescribed, only used in ED Proparacaine 1-2 drops
78
What is retinal detachment?
Separation of sensory retina from the pigment epithelium and ulderlying choroid
79
What causes retinal detachment?
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
80
When can permanent blindness occur in retinal detachment?
If the macula detaches because this is the central vision/highest acuity of vision
81
What does retinal detachment cause?
Ischemia and rapid progressive photoreceptor degeneration because blood source to retina is gone
82
Who often gets spontaneous retinal detachments?
Those patients that have a predisposition to it
83
What age group usually gets retinal detachments?
ages 50-75
84
What are risk factors for retinal detachments?
Myopia Previous ocular surgery like cataract extraction Fluoroquinolone use Trauma to eye Family history like lattice degeneration Marfan disease
85
What is the clinical presentation of retinal detachment?
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
86
What are the differential diagnoses of retinal detachment?
Viteous hemorrhage Vitreous inflammation Ocular lymphoma Intraocular FB
87
What would you see on ophthalmoscopic exam in retinal detachment?
Retinal hydration lines or "billowing sail" or "ripple on a pond"
88
What is the treatment for retinal detachment?
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
What is laser photocoagulation?
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
What is cryotherapy to the sclera?
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
What is pneumoretinopexy?
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
What is a scleral buckle placement?
in OR injection of lidocaine --> Cryoretinopexy performed --> Suture explant to sclera --> Explant indents wall of eye and closes retinal break --> adhesion forms
93
What is optic neuritis associated with?
Demyelinating diseases like MS
94
What is optic neuritis characterized by?
normal fundus exam initially Doctor sees nothing and patient sees nothing
95
Who is most likely to get optic neuritis?
20-40 years old Females White > black
96
What causes optic neuritis?
``` Demyelination/MS Sarcoidosis Neuromyelitis optica Herpes Zoster Systemic Lupus Erythematosus ```
97
What are the clinical manifestations of optic neuritis?
``` 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
What are the differential diagnoses for optic neuritis?
Infections involving optic nerve Retinal detachment Giant cell arteritis
99
What will develop in optic neuritis?
Optic atrophy or optic disk pallow over several months
100
What should you do if you suspect optic neuritis?
Get a brain MRI to assess for demyelinating plaques/MS
101
How do you treat optic neuritis if placques are found?
Interferon beta -1a
102
How should you manage optic neuritis?
Consult a specialist Coritcosteroid use is controversial
103
What is papilledema caused by?
``` 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
What are the three stages of papilledema?
Early Fully developed Chronic
105
What are the clinical manifestations of Early papilledema?
Loss of sponateous venous pulsations Optic cup retained
106
What are the clinical manifestations of fully developed papilledema?
``` 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
What are the clinical manifestations of late chronic papilledema?
Cup remains obliterated Hemorrhagic and exudative components resolve Nerve appears flat with irregular margins Disk Pallor
108
What are some signs of increased ICP?
``` 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
How do we diagnose papilledema?
MRI or CT Lumbar puncture for opening pressure Visual field testing
110
How do we treat papilledema?
``` 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
What are the clinical manifestations of Idiopathic intracranial hypertension?
``` N/V Headaches Blurred vision Double vision on lateral gaze Bilateral papilledema Spontaneous venous pulsations are absent Visual field defects ```
112
Who is idiopathic intracranial hypertension most common in?
Obese females of childbearing age
113
How do we treat idiopathic intracranial hypertension?
``` 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
What are differential diagnoses of idiopathic intracranial hypertension?
Hypertensive retinopathy | Pseudopapilledema = optic disk drusen
115
What is retinal artery occlusion considered a form of?
STROKE
116
What are the types of retinal artery occlusions?
central (CRAO) | Branch (BRAO)
117
Which type of retinal artery occlusion is most common?
Central
118
What types of patients get retinal artery occlusion?
those 60-65 Men Have HTN, smoke, diabetes, or high cholesterol
119
What is retinal artery occlusions caused by?
CAROTID ARTERY ATHEROSCLEROSIS --> strokes of eye Cardiogenic emobolism in afib Giant cell arteritis Sickle cell disease Hypercoagulable states Carotid artery dissection --> UNILATERAL HEADACHE
120
What are the clinical manifestations of central RAO?
Sudden, profound vision loss in one eye PAINLESS May be proceeded by transient monocular blindness, stuttering, or fluctuating course
121
What are the clinical manifestations of branch RAO?
Monocular vision loss which may be restricted to just a part of the visual field
122
How do we diagnose retinal artery occlusion?
Visual acuity is reduced RAPD Ischemic retinal whitening and "cherry red spot" in macula on fundoscopic exam
123
How do we treat retinal artery occlusion?
Check ESR and CRP to rule out Giant cell arteritis | Consult ophthamology immediately because irreversible retinal damage can occur within hours
124
What is retinal vein occlusion?
occluded retinal vein from thrombus formation or compression of the vein in retinal arterioles at the arteriovenous crossing point
125
What are the types of retinal vein occlusion?
Branch (BRVO) Central (CRVO) Hemiretinal (HRVO)
126
What is branch RVO?
distal vein is occluded leading to hemorrhage along distribution of a small vessel
127
What is central RVO?
Occurs due to thrombus within central retinal vein leading to involvement of the entire retina
128
What is hemiretinal RVO?
Occurs when blockage is in a vein that drains the superior or inferior hemiretina
129
What conditions are associated with retinal vein occlusion?
``` Diabetes Hypertension Leukemia Sickle cell disease Multiple myeloma ```
130
What is the clinical presentation of retinal vein occlusion?
Sudden, painless loss of vision
131
What might we see on a fundoscopic exam of someone with retinal vein occlusion?
Few scattered retinal hemorrhages and cotton wool spots to a marked hemorrhagic appearance
132
How do we treat retinal vein occlusion?
``` 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
What is a hordeolum?
a stye Acute, purulent, inflammation of eyelid May be sterile or show bacteria
134
What is the most common pathogen that causes hordeolum?
STAPH
135
What are the types of hordeoli?
Internal --> infection of meibomian gland on conjunctival side exernal --> infection of eyelash follicle on lid margin
136
How do we treat hordeolum?
Warm compresses +/- antibiotics May harden and form a chalazion
137
What is a chalazion?
chronic inflammatory lesion
138
What causes a chalazion?
blockage and swelling of Meibomian glands of eyelid
139
Who are chalazions commonly seen in?
patients with eyelid margin blepharitis and rosacea patients ages 30-50
140
What are the clinical manifestations of chalazions?
May start as small, red, tender, swollen area Within 2-3 days it becomes painless and large, rubbery, and nodular lesion
141
How do we treat chalazions?
Self-limiting and will resolve in weeks to months Warm compresses Eyelid massages
142
What is an ectropion?
lower eyelid is rolled out
143
What is ectropion caused by?
aging Facial nerve paralysis Certain dog breeds are prone to getting them
144
What are the clinical manifestations of ectropions?
``` 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
How do we treat ectropions?
Temporary --> artificial tears or ointments | Permanent --> shorten and tighten lower lid
146
What is an entropion?
eyelid rolls inward toward the eye and eyelashes rub against conjunctiva
147
What is an entropion caused by?
Aging and weakening of certain muscles Trauma Scarring Surgery
148
What are the clinical manifestations of an entropion?
``` Red eyes Irritation Gritty sensation Tearing Mucous drainage Photophobia Susceptible to corneal abrasions Won't see eyelashes ```
149
How do we treat entropions?
Artifical tears temporarily | Tighten eyelid and its attachments to restore eyelid position
150
What is dacryoadenitis?
Inflammation of the lacrimal glands
151
What is dacryoadenitis caused by?
Bacteria Viruses Fungi Inflammatory diseases
152
What bacteria cause dacryoadenitis?
``` Staph aureus strep N. gonorrhea Treponema M. Tb Chlamydia Borrelia burgdorferi ```
153
What viruses cause dacryoadenitis?
``` Mumps EBV Coxackie Herpes Zoster Mononucleosis ```
154
What fungi cause dacryoadenitis?
Histoplasma Blastomycosis Parasites Protozoa
155
What inflammatory diseases cause dacryoadenitis?
Sarcoidosis | Grave's Sjoren's
156
Who is dacryoadenitis most commonly seen in?
Children and neonates
157
What are the clinical manifestations of acute dacryoadenitis?
``` 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
What are the clinical manifestations of systemic dacryoadenitis?
Fever parotid gland enlargment URI Malaise
159
What are the clinical manifestations of chronic dacryoadenitis?
BILATERAL painless enlargment Present more than 1 month more common than acute
160
How do we diagnose dacryoadenitis?
see enlarged gland if everting eyelid | CT scan of orbits with contrast
161
How do we treat dacryoadenitis?
Virus is self-limiting and supportive care Bacterial = FIRST GEN CEPH --> KELFLAX antiaemoebic or antifungal treat inflammatory disease accordingly
162
What is Dacryostenosis?
Nasolacrimal duct obstruction Most common cause of persistent tearing in infants
163
How do we treat Dacryostenosis?
Massage Lacrimal duct probing Spontaneous resolution by 6-12 months
164
What is blepharitis?
chronic eye condition characterized by inflammation of eyelids
165
Which type of blepharitis is most common?
Posterior
166
What is anterior blepharitis?
inflammation of the base of the eyelid or eyelahses
167
What is anterior blepharitis caused by?
Staph | Seborrheic Dermatitis
168
Who does anterior blepharitis most commonly seen in?
young females
169
What is the pathophysiology behind anterior blepharitis?
Allergic response to staph antigens that colonize the eyelids
170
What is the clinical presentation of anterior blepharitis?
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
What is posterior blepharitis associated with?
Rosacea and seborrheic dermatitis
172
What is posterior blepharitis caused by?
``` 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
What are the clinical manifestations of posterior blepharitis?
``` Red eyes Gritty sensation Burning Excessive tearing Itchy eyelids Crusting Flaking eyelid skin Photophobia Blurred vision ```
174
How do we treat blepharitis?
``` 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
What is the major cause of blindness from corneal scarring worldwide?
Herpes Simplex keratitis
176
What is Herpes simplex keratitis?
Corneal infection and inflammation
177
How is herpes simplex keratisis transmitted?
Direct contact with mucous membrane
178
What is the most common type of herpes simplex keratitis?
Infectious epithelial keratitis
179
What are the types of herpes simplex keratitis?
Infectious epithelial keratitis Stromal keratitis --> viral infection of stroma Endotheliitis --> immune reaction Neurotrophic keratopathy --> corneal hypesthesia from damage to optic nerve
180
What is the incubation period of herpes simplex keratitis?
1-5 days
181
What is the pathophysiology behind herpes simplex keratitis?
Active infection Inflammation caused by infection Immune reaction This results in stuctural change in the cornea
182
What is the clinical presentation of herpes simplex keratitis?
pain Visual burning Tearing
183
How do we diagnose herpes simplex keratitis?
Dendritic lesions on fluorescein
184
How do we treat herpes simplex keratitis/
Topical antivirals for mild cases: Trifluridine Ganciclovir Acyclovir in europe Oral agents in severe cases: Valacyclovir Famcyclovir Gancyclovir
185
What portions of the eye does preseptal/periorbital cellulitis effect?
Upper and lower lid and nothing else
186
Who is preseptal/periorbital cellulitis most commonly seen in?
children
187
What causes preseptal/periorbital cellulitis?
``` Insect bites Animal bites FB Dacryocystitis Conjunctivitis Hordeolum S. aureus S. pneumoniae MRSA ```
188
What are the clinical manifestations of preseptal/periorbital cellulitis?
``` Ocular pain Eyelid swelling Erythema Warmth Skin infection like symptoms ```
189
How do we diagnose preseptal/periorbital cellulitis?
CT or MRI will distinguish between preseptal or orbital
190
How do we treat preseptal/periorbital cellulitis?
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
What is orbital cellulitis?
Infection involving contents of orbit such as fat and muscle but not the globe
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What is the common source of most cases of orbital cellulitis?
Rhinosinusitis
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Who is orbital cellulitis most common in?
children
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What pathogens cause orbital cellulitis?
S. aureus | Strep
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What are other causes of orbital cellulitis?
Orbital trauma Dacryocystitis Tooth infection Ophthalmic surgery
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What are the clinical manifestations of orbital cellulitis?
``` Swelling Erythema Warmth Ophthalmoplegia Proptosis Pain with eye movement Diplopia ```
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What are complications of orbital cellulitis?
Orbital abscess Subperiosteal abscess Brain abscess Cavernous sinus thrombophlebitis
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How do we diagnose orbital cellulitis?
CT or MRI
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How do we treat orbital cellulitis?
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
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Who are most likely to get conjunctivitis?
Contact wearers and its usually pseudomonas related
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What are red flags assocaited with conjunctivits?
``` Reduction of visual acuity Ciliary flush Photophobia Fixed pupil Corneal opacity Severe headache with nausea ```
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What is bacterial conjunctivitis caused by?
S. aureus --> adults usually S. pneumoniae H. flu
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How is bacterial conjunctivitis spread?
highly contagious and through direct contact
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Who is bacterial conjuncitivits most common in?
childen
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What are the clinical manifestations of bacterial conjunctivitis?
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
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How do we diagnose bacterial conjunctivitis/
Flueorescein | Fundoscopy
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What is the first line treatment for bacterial conjunctivitis?
ERYTHROMYCIN ointment or trimethoprim-polymyxin drops
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What is the first line treatment for contact wearers for bacterial conjunctivitis?
FLUOROQUINOLONE drops
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What are other treatments for bacterial conjunctivitis?
Bacitracin or sulfacetamide ointment
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What causes viral conjunctivitis?
adenovirus
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How is viral conjunctivitis spread?
Direct contact and highly contagious
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What is the clinical presentation of viral conjunctivitis?
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
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How do we diagnose viral conjunctivitis?
Rapid test for adenovirus
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How do we treat viral conjunctivitis?
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
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What is allergic conjunctivitis caused by?
Airborne allergen that comes in contact with eye
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What is the clinical presentation of allergic conjunctivitis?
``` VERY ITCHY EYES BILATERAL EYE REDNESS burning Irritation Watery discharge Morning crustiness Marked chemosis Infraorbital edema/allegic shiners ```
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How do we treat allergic conjunctivitis?
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
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What is toxic conjunctivitis caused by?
Smoke Liwuid Fumes Chemicals
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How do we treat toxic conjunctivitis?
Tetracaine drops Immediate flushing of eye Get pH to neutral

Clinical Medicine I (15 decks)

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